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Oncology > General > Flashcards

General Flashcards

1
Q

cell cycle phases

A

interphase:
G1 - growth and prep: DNA check for damage
S - synthesis: make more DNA
G2 - prep for mitosis, grow, final check

mitosis
Please = prophase: pair up
Make = metaphase, meet in middle
Another = anaphase, spindles pull apart
Two = telophase -> NM forms again
Cells = cytokinesis

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2
Q

types of genes involved in cancer (like what kind can go wrong)- and which require two mutated alleles

A
  • tumour suppressor - both alleles
  • protooncogenes - one
  • DNA repair genes - one
  • genes for telomeres - one
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3
Q

EBV associated with what cancers?

A

diffuse large B cell lymphoma
Hodgkin lymphoma
post-transplant lymphoproliferative disorder
Burkitt’s lymphoma
nasopharyngeal
leiomyyo
gastric adenocarcinoma

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4
Q

HHV8 associated with what cancers?

A

Kaposi’s sarcoma
(primary effusion B cell lymphoma)
(plasma cell variant of castleman disease)

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5
Q

which syndromes involve inactivation of tumour suppressor genes?

A

Li-Fraumeni (P53)
NF1 and NF2
Familial retinoblastoma
Von Hippel-Lindau
Tuberous sclerosis (TSC1 or TSC2)

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6
Q

which syndromes involve inactivation of DNA repair genes?

A

fanconi anaemia
bloom syndrome
xeroderma pigmentosum
ataxia telangiectasia

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7
Q

leukostasis: key features

A

AML most likely
it so thicc, nothing can get through:
hypoxia, dyspnoea, LOC, haemorrhage bc the blasts consume coag factors

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8
Q

how to treat leukostasis

A
  • hyperhydration
  • hydroxyurea
  • induction chemo
  • w/h RBCs
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9
Q

TLS: key features

A
  • high K, PO4, uric acid
  • low Ca, acidosis, AKI
  • causing AKI, arrhythmia, siezures, tetany
  • rapid tumours: ALL >100 WCC, lymphoma esp Burkitt, renal disease
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10
Q

Tx of TLS

A

low risk = allopurinol
high risk = rasburicase - degrades uric acid to allantoin
hyperhydration

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11
Q

allopurinol should never be given with which drug and why?

A

6MP/ azathioprine:
- Azathioprine activated by conversion to 6MP
- 6MP inactivated by xanthine oxidase
- Can cause life threatening bone marrow suppression

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12
Q

coagulopathy esp with which cancer

A

APML
i. Low fibrinogen very suggestive
ii. Elevated D-dimer
iii. Reduced platelets

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13
Q

mediastinal compression: which cancers, and what to do?

A

T cell ALL (two thirds) + lymphoma
- Vena caval compression and bronchotracheal compression > facial oedema, dyspnoea and orthopnoea
- look for pericardial effusion on CXR and avoid GA

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14
Q

who is at high risk of feb neut?

A

AML
ALL induction / delayed intensification
allogeneic transplant (day-14 to day+356)
autologous transplant (day-7 to day +30)
re-induction chemotherapy for any relapse.

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15
Q

Rx for feb neut

A
  1. tazocin (cefepime/ceftaz if allergic)
    +/- amik if sick / high risk
    +/- metro for abdo stuff
    +/- vanc if suspect MRSA
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16
Q

alklyating agents - cyclo/ifos:
- action
- cell cycle
- indications

A
  • add alkyl groups > break DNA
  • resting phase!
  • solids: NHL, wilms, NB
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17
Q

anti-metabolites (MTX, 6-mp, ara-c):
- action
- cell cycle

A
  • Similar structure to naturally occurring molecules in synthesis (MTX = folate, 6-MP = purine, ara-c = pyrimidine)
  • S (cell growth)
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18
Q

MTX = ?

A

vom +++, hepatitis, mucositis
hyperhydration

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19
Q

6-MP = ?

A

myelosuppression, hypoglycaemia
ALL
beware allopurinol

20
Q

vinca alkaloids (vinc):
- action
- cell cycle

A

binds tubulin inhibiting spindle formation in MITOSIS

21
Q

vincristine key features

A

constipation
Neuropathy (peripheral sensorimotor, autonomic)
jaw pain
extravasation

NOT emetogenic with minimal BM suppression

22
Q

topoisomerase inhibitors
- action
- cell cycle

A

disrupt topoisomerase
S (irinotecan) and G2 (etop)

23
Q

etoposide = ?

A

2nd leukaemia

24
Q

anthracyclines (doxo/dauno)
- action
- cell cycle

A

increase free radicals > oxidative stress
G2/M

25
Q

doxo/dauno = ?

A

cardiomyopathy - dexrazoxane

26
Q

platins (carbo/cisplat)
- action
- cell cycle

A

binds to dna to cause death
cell cycle non specific

27
Q

carboplatin and cisplatin = ?

A

carboplat = anaphylaxis
cisplat = vom +++, ototox, renal tox

28
Q

l-/peg-asp: how it works and key features. which part of the cycle

A

converts circulating l-asp, and tumour cells can’t make their own, so they die (normal cells can). G1

ALL/AML only

pancreatitis, DIC, anaphylaxis, venous thrombosis, hyperglycaemia

29
Q

bleo = ?

A

lung fibrosis

30
Q

Bulsulphan = ?

A

seizures

31
Q

cyclo = ?

A

haemorrhagic cystitis (mesna), pulmonary fibrosis, infertility, HSV

32
Q

ifos = ?

A

RTA, encephalopathy (thiamine/methylene blue)

33
Q

ara - c = ?

A

n+v, mucositis, myelosuppression

34
Q

Drugs that cause minimal/no myelosuppression (4)

A

o vinca alkaloids
o enzymes (asparaginase)
o bleomycin
o steroids

35
Q

vincristine + intrathecal?

A

FATAL BITCH

36
Q

meds for each part of cell cycle

A

G1: asp, steroids
S: anti-metabolites, irinotecan
G2: etop
M: vinca, taxanes
all: cyclophos, platins, doxo

37
Q

first signs of vinc neuropathy? most comon and severe?

A

paraesthesia of fingertips and feet +/- muscle cramps (distal to proximal)
most common and severe = hyporeflexia

38
Q

risk factors for vinc neuropathy

A

1) Concomitant azole antifungals
2) Pre-eexisting neurological condition such as Charcot-Marie Tooth

39
Q

lung shit, think of which 4 CTx?

A
  1. MTX - penumonia
  2. cyclo - pneumonitis/fibrosis
  3. busulfan - fibrosis
  4. belo - fibrosis
40
Q

main side effects radiotherapy

A

acute: N/V, dermatitis, cerebral oedema

chronic: dose-dependent 2nd cancer, neurocognitive, vascular, eyes, ears, fertility, cerebral necrosis, myelitis, endo

41
Q

most to least common endocrinological complications of radiotherapy

A
  1. GH def (50%)
  2. Gonadotrophin deficiency or precocious puberty, females mostly (25%)
  3. Hyperprolactinemia
  4. ACTH deficiency
  5. Central hypothyroidism
42
Q

what is radiation recall dermatitis?

A

inflammatory skin reaction that develops in an area of previously irradiated skin AFTER administration of certain promoting agents

43
Q

what is radiation enhancement?

A

enhancement of the dermatological toxicity of radiation, if radiosensitizing chemotherapy administered within one week of the radiation

44
Q

which is the childhood malignancy which most commonly has secondary cancers?

A

Hodgkin’s lymphoma (10% in 10 years) and soft-tissue sarcomas higher than that of any other childhood cancers

45
Q

hodgkin’s = what 2nd cancers
ALL = what 2nd cancers

A

hodgkins = breast, thyroid, aml
ALL = brain, mds/aml

46
Q

AVN happens in what Mx

A

steroids + BMT

Oncology (4 decks)

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