General Oncology Flashcards
What cancer is associated with exposure to benzene?
Leukaemia
What cancer is the Epstein Barr virus associated with?
Hodgkins and non Hodgkin’s lymphoma
What cancer is associated with exposure to wood dust?
Nasal adenocarcinoma
What cancer is associated with exposure to vinyl chloride?
Angiosarcoma
What is the RECIST classification of imaging response to treatment?
Complete response - no disease detectable
Partial response - shrunk by >30%
Stable -shrunk by 20%
Progressive disease - new lesions or lesions that have increased by >20%
Who is eligible for mammography screening for breast cancer and how often?
Women from the ages of 50 to 65, every three years
How many CT scans does it take to cause one cancer?
1000 - 2000 ct scans
For what cancer is carcinoembryonic antigen raised, and in which other conditions may it also be raised?
Colorectal carcinoma
Smokers, IBD, hepatitis, pancreatitis, gastritis
For what cancer is CA125 raised, and in which other conditions?
Ovarian cancer- raised in 82%
Also raised in 6% of pregnancy, endometriosis, PID
Also raised in pancreatic, lung, colorectal and breast cancer
In what conditions is Alpha fetoprotein raised?
First year of life
Hepatitis
Hepatic ellipse carcinoma
Yolk sac cancers
In what conditions is human human chorionic gonadotropin raised?
Hydatiform mole
Choriocarcinoma
Non Seminomatous testicular cancer
When is PSA raised?
Prostate cancer BPH UTI After a DRE prostatitis
In which inherited condition is a prophylactic colectomy sometimes considered?
Familial Adenomatous Polyposis
Which chemo drugs can be taken orally?
Cyclophosphamide
Capacitabine
Etoposide
Tamoxifen
Which cancer an be treated with chemotherapy administered intraperitoneally?
Ovarian cancer
How is chemotherapy dose usually calculated?
Body surface area using the Dubois and Dubois calculations
For which cancers is high dose chemo with bone marrow support an option?
Non Hodgkin's lymphoma Hodgkin's Acute and chronic leukaemia Multiple myeloma Germ cell tumours Ewing's sarcoma
Which drugs are administered with chemo to prevent nausea and vomiting?
Pre med
Ondansetron 8mg IV
Dexamethasone 8mg IV
Post dose
Metoclopramide TDS 14 days
Dexamethasone 6mg PO
Which drugs are most at risk of causing peripheral neuropathies?
Platinums eg cisplatin, carboplatin
Vinca alkaloids eg vincristine
Taxanes eg paclitaxel, docetaxel
Which chemo drug may cause cerebellar toxicity?
5FU
Which chemo drug may cause cochlear damage resulting in permanent high tone loss?
Cisplatin
Which chemo drugs are nephrotoxic
Cisplatin
Isosfamide
Which chemo drugs pose a risk of haemorrhagic cystitis, and what is the antidote?
Cyclophosphamide
Isosfamide
Antidote is mesna
Which chemo drugs may cause cardiac arrythmia
Doxorubicin
Paclitaxel
Which chemo drug may cause coronary artery spasm?
5FU
Which chemo drugs may cause palmar plantar erythema?
5FU
Capacitabine
Sunitinib
Erlotinib
Which chemo drug may cause photo sensitivity?
5FU
Which chemo drug causes pigmentation changes
Bleomycin- also check for pulmonary fibrosis!
Which drug may cause myalgia/arthralgia
Paclitaxel
Which drugs may cause infertility?
Alkylating agents- cyclophosphamide, Isosfamide, melphalan, busulphan
What is the nadir point for myelosuppression?
10-12 days after treatment
Which cancers are most likely to cause bone narrow replacement by malignant infiltration, resulting in myelosuppression by pancytopenia?
Haematological
Breast
Lung
Prostate
How and when is anaemia treated cancer?
Hb <10 gldl
Blood transfusion
Recombinant epo if symptomatic
How does thrombocytopenia present in cancer, how is it treated?
Petechiae
Nosebleeds
Corneal haemorrhage
20x10*9- does not require platelets
When does neutropenia typically occur after chemo?
7-14 days
When is febrile neutropenia diagnosed?
WBC <1x10(9)
Fever greater than 38 degrees for an hour
Or fever greater than 38.5 degrees in a single reading
How is febrile neutropenia treated?
IV tazocin within 60 mins
Consider switch to oral within 24 hours
5% overall mortality
Mostly no identifiable aetiology
When does pneumonitis appear after radiotherapy, and what symptoms does it cause?
6-8 weeks after
Progressive SOB, dyspnoea
When do acute side effects develop during radiotherapy
During treatment
Peak during first few weeks post treatment and resolve
When do late side-effects develop during treatment
Develop greater than three months after radiotherapy.
May be years later
Often irreversible
Worsen over time
Include lung fibrosis, skin atrophy, infertility
What is the difference between intercavitary and interstitial brachytherapy
Intercavitary- placed in body such as uterus or cervix
Interstitial- placed into target such as prostate
Patient is radioactive so counsel about risk!
What is an example of radioisotope use in cancer treatment
Iodine 131 use in thyroid cancer
Preferentially taken up in normal or malignant thyroid tissue
Requires 4 days in lead lined room
Who is eligible for cervical cancer screening?
25-49 every three years
49-64 every five years
Only women because only women have cervices
What screening programme is used for colorectal cancer?
Faecal occult blood
Every two years
60-69
Currently being extended to 74
In which part of the spine does metastatic spinal cord compression most commonly occur?
2/3 thoracic
1/3 lumbar/cervical
What is the treatment for metastatic spinal cord compression
16mg dexamethasone
With PPI for gastric protection
8gy single fraction radiotherapy
Or refer to spine surgeons
What is the prognosis for metastatic spinal cord compression for patients ambulance and paraplegic prior to treatment?
Ambulant- 70% retain function
Paraplegic- 5% retain function
Overall one fifth of patients will survive greater than one year
What are the symptoms of superior vena cava obstruction?
Facial oedema
Prominent blood vessels
Cyanosis
What is the treatment for superior vena cava obstruction?
Dexamethasone 16mg
Vascular stenting followed by radiotherapy, chemo
What are the cardiac symptoms of hypercalcaemia?
Bradycardia
Short QT intervals
Prolonged PR interval
Wide T wave
How is rehydration managed in hypercalcaemia?
Rehydration with saline 1l 4 hourly for 24 hours
IV pamidronate 60-90mg over 2-4 hour
Calcitonin and corticosteroids?
What are the signs that someone is nearing the end of their life?
Profound weakness Confined to bed Disorientated Confused Drowsiness for extended periods Reduced attention Loss of attention in food and drink Too weak to swallow
When is a blood transfusion indicated in cancer?
Prognosis >2 weeks
And
Symptoms of anaemia
And
Hb <8g/dl
In what order are muscles affected in corticosteroid induced myopathy?
Legs then arms then chest muscles
Proximal muscles are affected before distal muscles
What are the symptoms of metastatic spinal cord compression?
Low back pain - band like, increased in movement, coughing, or lying flat
Motor weakness
Subjective sensory disturbance
Bladder/bowel dysfunction
Increased reflexes
Clonus
What is the investigations for MSCC?
MRI within 24 hours
FBC, calcium, LFTs (raised all phosphate)
What causes superior vena cava obstruction?
Extrinsic compression, thrombosis or invasion if the wall of the vessel
Usually in lung cancer, lymphoma
What are the symptoms of SVCO?
Facial oedema
Prominent blood vessels
Cyanosis
How is SVCO managed?
Dexamethasone 16 mg
Vascular stenting - may be followed by radiotherapy, chemo
What cancers commonly cause hypercalcaemia?
Breast cancer Lung cancer - NSCLC SCC Myeloma/lymphoma Head and neck
