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Haem Onc Flashcards

1
Q

presentation of SVCO
what is most common symptom

A

dyspnoea - most common
facial plethora
distended neck veins
headache

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2
Q

rx of SVCO

A

stent
chemo
dexamethasone

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3
Q

rx of malignant spinal cord compression

A

immobilise patient
loading dose 16mg dexamethasone
Urgent MRI whole spine within 24hrs

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4
Q

what type of cancer is prostate cancer
what is usual location

A

adenocarcinoma
peripheral zone

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5
Q

how is prostate cancer graded

A

gleason score - 2 grades given and added together - worse score is 10, best is 2

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6
Q

what can cause false positives for PSA

A

prostatitis
?DRE
UTI
BPH
exercise
ejaculation

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7
Q

RF for prostate cancer

A

increasing age
fhx
afro caribbean

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8
Q

presentation of prostate Ca

A

hesitancy
Retention
irregular hard prostate on PR
haematuria
back pain

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9
Q

first line ix of prostate cancer

A

multi parametric MRI

go on to do staging CT after if needed

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10
Q

Rx of prostate cancer
- localised
- locally advanced
- metastatic

A
  • can do conservative with active monitoring, radical prostatectomy or radio
  • GnRH agonists eg goserelin, radical prostatectomy, radiotherapy
  • radiotherapy, hormone treatments or palliative
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11
Q

How do GnRH agonists work in prostate cancer

A

initially cause a rise in testosterone - ‘tumour flare’ but then due to negative feedback it falls in about 2-3 weeks to castration levels

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12
Q

common complications of radical prostatectomy

A

urinary incontinence and erectile dysfunction

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13
Q

Breast cancer rx if
- ER +ve perimenopause
- ER +ve post menopause
- HER2 +ve

A
  • SERM - tamoxifen
  • aromatase inhibitors eg anastrozole
  • Herceptin + more recptove to chemo

lobotomy, mastectomy, ± axillary lymph node clearance, radiotherapy

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14
Q

Complication of aromatase inhibitors

A

osteoporosis - do DEXA scan

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15
Q

types of melanoma

A

lentigo
nodular
superficial spreading

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16
Q

grading of melanoma

A

breslows depth

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17
Q

shave vs punch biopsy for melanoma

A

shave doesn’t show whether its invasive as only samples epidermis, but can used for smaller lesions and won’t leave scar

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18
Q

rx of melanoma

A

curative - excision ±lump nodes
Chemo
Palliative
Topical imiquimod - immunotherapy

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19
Q

major and minor features of melanoma

A

major
- change in size
- change in colour
- change in shape

minor
- oozing or bleeding
- diameter >7
- altered sensation
- inflammation

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20
Q

excision margins based on breslows depth

A

Lesions 0-1mm thick 1cm
Lesions 1-2mm thick 1- 2cm
Lesions 2-4mm thick 2-3 cm
Lesions >4 mm thick 3cm

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21
Q

single most important prognostic factor in melanoma

A

breslows depth

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22
Q

colorectal cancer presentation

A

change in bowel habit
rectal bleeding
unexplained weight loss
bowel obstruction
abdo pain

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23
Q

2ww referral criteria for colorectal cancer

A

> 40 with unexplained weight loss and abdominal pain
50 with unexplained rectal bleeding
60 with iron deficiency anaemia or changes in bowel habit

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24
Q

what test is used first line for colorectal cancer since 2023

A

FIT testing

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25
Q

colorectal cancer screening programme

A

FIT test, age 60 -74 every 2 years

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26
Q

inherited colon cancers, which is most common

A

hereditary non polyposis colorectal carcinoma (Lynch syndrome) - most common inherited
Familial adenomatous polyposis

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27
Q

ix for staging in CRC

A

CEA
staging CT CAP
colonoscopy

TNM or dukes staging

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28
Q

name of surgery if cancer is
- right/transverse colon
- left
- sigmoid/upper rectum
- anal

A
  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • abdominoperineal resection of the rectum
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29
Q

what is hartmanns procedure

A

sigmoid resection + end colostomy

30
Q

rf for colorectal cancer

A
  • smoker
  • increasing age
  • male
  • fix - FAP + HNPCC
  • IBD
31
Q

common side effects of chemo

A

N+v
chemo brain
weakened immune system - (bone marrow supression)
mouth sores
bruising and bleeding (thrombocytopenia)

32
Q

side effects of radiotherapy
- early and late

A

Early:
skin reactions, mucositis, N+D, fatigue

Long term:
secondary malignancy
endocrine - irreversible diabetes and hypothyroidism
Neural or vascular damage

RADIATION PNEUMONITIS - chest pain, cough, fevers

33
Q

side effects of immunotherapy

A

every -itis
hepatitis, scleritis, pneumonitis, myocarditis, nephritis, etc

34
Q

Toxicity bear

A

cisplatin - ototoxic, nephrotoxic
Bleomycin - pulmonary fibrosis
vincristine - peripheral neuropathy
Doxorubicin - cardiac issues
Cyclophosphamide - bladder cancer
Methotrexate - pulmonary fibrosis

35
Q

what is myeloma and its features
when does it present

A

proliferation of plasma cells
Hypercalcaemia - light chains stimulate osteoclasts
AKI - accumulation of light chains
Paraproteinaemia
Anaemia - bone marrow crowding surpasses erythopoeisis

peak age is 70

36
Q

ix of myeloma

A

bone profile
FBC
protein electrophoresis - increased IgA/G in serum and Urinary bence jones proteins
U+Es - aki
Bone marrow biopsy - >10% plasma cells
Blood film - roleaux formation
Xray - osteoporosis
whole body MRI - lytic lesions

37
Q

rx of myeloma

A

chemo + stem cell transplant + radiotherapy for bone pain and zolendronic acid to prevent bone disease

38
Q

what is AML
what age group

A

proliferation of myeloblasts
adults - incidence increases with age

39
Q

AML presentation

A

Symptoms of pancytopenia and general cancer sx

40
Q

Rx of AML

A

chemo and regular blood transfusions
palliative - pretty poor prognosis

41
Q

Most common haem cancer in children

A

ALL

42
Q

which haem cancer is associated with down syndrome

A

ALL

43
Q

Pathophys of CML

A

proliferation of basophils, neutrophils, eosinophils etc

44
Q

Presentation of CML
What chromosome is it associated with

A

High white cell counts and massive splenomegaly
Can progress ti AML

45
Q

Rx of CML

A

Tyrosine kinase inhibitors eg imatinib
generally have long remissions and normal life expectancy

46
Q

FBC in chronic vs acute leukaemia

A

chronic - leukocytosis
acute - pancytopenia

47
Q

Complications of CLL

A

Richters transformation - CLL to lymphoma
Hypogamaglobulinaemia - recurrent infections

48
Q

who is CLL more common in

A

elderly

49
Q

why is LDH high in cancers

A

bc high cell turnover

50
Q

causes of pancytopenia

A

AML and ALL
sepsis/DIC
myelodysplasia
SLE
Radio/chemotherapy
Drugs that cause bone marrow suppression

51
Q

Pathophys of myelodysplasia and what can it progress to

A

Abnormal myeloid progenitor cells that clog bone marrow causing pancytopenia
Can progress to AML

52
Q

How is a progression to AML from myelodysplasia identified

A

> 20% abnormal cells in the bone marrow

53
Q

Rx of myelodysplasia

A

RBC and plt transfusions
Abx for infections
stem cell transplant
chemo eg azacitidine to prevent AML progression

54
Q

rf for hodgkins

A

prev EBV infection,
HIV
RA and sarcoidosis
Fhx
age - bimodal - peaks at 20 and 75

55
Q

ix for Hodgkins

A

lymph node biopsy - reed sternberg cells
LDH
Staging CT

56
Q

How many sets of lymph nodes does hodgkins usually affect

A

just 1

57
Q

Staging system for lymphoma

A

Ann Arbor
1 - 1 set of lymph nodes
2 - 2 sets on same side of diaphragm
3 - 2 sets on opposite sides of diaphragm
4 - organ involvement

58
Q

Rx of hodgkins

A

ABVD or RCHOP chemo
Radiotherapy

59
Q

compare hodgkins an non hodgkins

A

non hodgkins more common, tends to affect more than one set of lymph nodes, older pts, extra nodal involvement more common

60
Q

what is essential thrombocytosis and what are pts at increased risk of

A

JAK2 mutation causing increase in platelets
risk of clots, bleeding (bc plus bind to vWF causing reduced availability) and miscarriage

61
Q

Rx of essential thrombocytosis
- if low risk of clots
- if high risk of clots

A
  • aspirin, monitor
  • hydroxyurea, interferon alpha, plateletpheresies
62
Q

what is polycythaemia vera and features

what are they at increased risk of

A

JAK2 mutation causing overproduction of RBCs
- fatigue, dizziness, itchy after hot shower, splenomegaly, redness, gout

risk of clots!

63
Q

Rx of PCV

A

regular phlebotomy
hydroxurea
Ruxolitinib - JAK2 inihibtor
Aspirin for clot prevention
antihistamines for itch

64
Q

rx of neutropenic sepsis

A

IV tazocin
Give vanc if concerned about line infection
G CSF to stimulat neutrophil production

65
Q

lab results and presentation of tumour lysis syndrome

A

hyperkalaemia
hyperphosphataemia - hypocalcaemia
increased uric acid

Arrythmias
Hypocalcium - tingling, muscle spasm, tetany, seizures
AKI - uric acid

66
Q

who is at risk of tumour lysis

A

large tumour burden
rapidly dividing cancers eg AML, high grade lymphomas

67
Q

when does tumour lysis occur

A

can occur spontaneously before treatment but most common in first few weeks after treatment

68
Q

Rx of tumour lysis syndrome

A

Fluid resus
Allopurinol (xanthine oxidase inhibitor) to reduce uric acid levels
Rasburicase - converts uric acid so it is easily secreted
May need temp dialysis bc of electrolyte imbalances

69
Q

rx options for mucositis

A

difflam mouthwash
oramorph
tranexamic acid mouthwash if bleeding heavily from mouth

70
Q
A

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