Gems

Question 1

PET for lung cancer upstages what proportion

Answer 1

30%

Question 2

If take off a superficial bladder cancer, what is the risk of it coming back without further treatment

Answer 2

70%

Need intravesical BCG or CTx- gemcitabine or mitomyxin

Question 3

Risk factor for bowel cancer recurring post resection

Answer 3

resect fewer than 11 LN

Question 4

How many doses of IPI?

Answer 4

4 doses

Transient worsening before disease progression

Question 5

Treat autoimmune colitis

Answer 5

steroids

if not better in 48 hours then give infliximab

Question 6

How is ifosfamide nephrotoxic

Answer 6

Tubular dysfunction

Question 7

Pall care person falling asleep , pain well controlled

Answer 7

consider psychostimulants like dexamphetamine and modafenil

Question 8

p53 function

Answer 8

• 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

Question 9

2 main factors for determining local recurrence

Answer 9

margins

presence or absence of extensive in situ component

Question 10

2 main factors for ipsilateral recurrence

Answer 10

lymphatic invasion
age under 35

also size over 2 cm
and higher grade

NOT subtype or nodal status

Question 11

most common gene mutation associated with renal clear cell

Answer 11

VHL

when this is silenced by second hit or methylation, Hypoxia inducible factor (HIF) accumulates

Question 12

IN colorectal cancer, KRAS, BRAF and EGF pathways all mediated via MAPK (and EGF via PI3K as well). What is the clinical difference>

Answer 12

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

Question 13

DNA damage from radiation is mended by what mechanism usually?

Answer 13

nucleotide excision repair

Question 14

how do you diagnose pheo compared with carcinoid tumour

Answer 14

pheo 24 hour urinary metanephrines or VMA

carcinoid urine 24 hour 5-HIAA

Question 15

Best drug combination for highly nauseating chemo?

Answer 15

dex
aprepitant
5HT3 antag

Question 16

bisphos or denosumab better in castration resistant prostate cancer with bony mets?

Answer 16

denos
may be superior in breast
non inferior in non breast non prostate

good in renal dysfunction
hypocalcaemia more common

Question 17

ADT in prostate cancer what effect on bone mets?

Answer 17

increase risk of fracutre

Question 18

which are the only sarcomas where chemo is used?

Answer 18

Ewing and rhabdomyosarcoma

Question 19

SVC BUT UNKNOWN TUMOUR- DO WHAT?

Answer 19

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

Question 20

age group breast cancer screening

Answer 20

50-69

causes 14-32% mortality reduction as long as your life expectancy is 5 years or more

Question 21

normal PSA and prostate cancer

Answer 21

does not rule out

Question 22

what is the concept of free PSA

Answer 22

PSA from cancer cells tends to bind more avidly to proteins, so free PSA percentage is low

Question 23

when do you get chemo in breast cancer surgery

Answer 23

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

Question 24

how to screen a brca woman

Answer 24

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

Question 25

When do you use cetuximab

Answer 25

head and neck squamous cell

EGFR positive, KRAS WILD type colion cancer

Question 26

When is trasuzumab used

Answer 26

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

Question 27

Erlotinib MOA

Answer 27

REVERSIBLE
TKI
targets MULTIPLE receptors
including VEGF2 and 3 receptors, PDGFR B, FLT 3 and cKIT

Question 28

GBM treatment

Answer 28

adjuvant chemoradiotherapy (radio increases the sens to chemo) then chemo alone after dubulking the GBM
Use temzolomide

Question 29

Teratoma tumour markers

Answer 29

beta HCG and AFP negative
only treatement is surgerys
no role chemo radio

Question 30

Choriocarcinoma where do they like to go

Answer 30

bleed in the BRAIN

Question 31

choriocarcinoma tumour markers

Answer 31

beta HCG in the THOUSANDS SUPER SUPER HIGH

Question 32

If see long bone mets sparing vertebral column, think…

Answer 32

gastric primary

Question 33

management of seminoma and non seminoma stage 1

Answer 33

seminoma probably give 1 dose carboplatin

non seminoma 1-2 cycles BEP

Question 34

WHat does sunscreen do?

Answer 34

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

Question 35

What does SJS look like

Answer 35

blistering lesions 
TRUNK
almost always MUCOSAL too
4-21 days after first dose drug 
full thickness epidermal necrosis
also febrile, photophobia, sore throat, dysphagia

Question 36

What happens in porphyria cutanea tarda?

Answer 36

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

Question 37

most common cause of erythema nodosum

Answer 37

strep pharyngitis!!

also seen in TB, sarcoid, IBD, cancer, deep fungal, OCP