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FRACP NOSH 2020 > Medical Oncology > Flashcards

Medical Oncology Flashcards

1
Q

What is the incidence of breast cancer among Australian women?

A

1/8

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2
Q

What percentage of breast cancer is gene-related?

A

5-10%

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3
Q

Which gene is most common one to be associated with hereditary breast cancer?

A

BRCA1 (20-40%)

BRCA2 (10-30%)

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4
Q

Which BRCA gene is associated with prostate cancer in men?

A

BRCA2

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5
Q

What is the mode of transmission of BRCA genes?

A

Autosomal dominant

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6
Q

For breast cancer, which imaging modality is most sensitive in pre-menopausal women?

A

MRI breast

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7
Q

What is the best chemoprevention option for breast cancer in BRCA positive premenopausal women?

A

Tamoxifen

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8
Q

What age group receive screening mammography?

A

Age 50-74

Still free for women over 40

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9
Q

Which palpable breast masses need to be biopsied?

A

All of them!

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10
Q

What is the general purpose of adjuvant chemotherapy?

A

To eliminate micro-metastatic disease, to prevent relapse

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11
Q

What effect does HER2 positivity status have on breast cancer prognosis?

A

Confers poorer prognosis

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12
Q

In early stage breast cancer, what type of adjuvant chemotherapy is generally used?

A

Anthracycline and/or taxane based

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13
Q

In early stage breast cancer, what is the indication for axillary node dissection?

A

A clinically positive node pre-op

Consider if sentinel node biopsy positive

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14
Q

As adjuvant therapy in breast cancer, how long should Tamoxifen be given?

A

5 years for lower risk

10 years for high risk

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15
Q

What is the most effective adjuvant chemotherapy for breast cancer in postmenopausal women?

A

Aromatase inhibitors.

Block conversion of DHEA to oestrogen

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16
Q

What are the indications for adjuvant radiotherapy in early stage breast cancer? (2)

A

After breast conserving surgery

Post mastectomy in breast cancer >5cm per lymph node positive

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17
Q

What is the treatment of choice for metastatic breast cancer which is ER+/HER2- ?

A

Endocrine therapy =

Aromatase inhibitors
Tamoxifen
Fulvestrant

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18
Q

What is the treatment of choice for metastatic breast cancer that is HER2+ ?

A

Trastuzumab + pertuzumab + taxane chemo

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19
Q

What is the treatment of choice for metastatic breast cancer that is triple negative?

A

Chemotherapy =

Sequential single agent, many different options

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20
Q

What are the 4 main histological subtypes of lung cancer, in order of frequency?

A

Adenocarcinoma -40%
SCC - 20%
Small cell - 13%
Large cell - 7%

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21
Q

What defines ‘limited stage’ in small cell lung cancer?

A

All disease is within one radiation field

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22
Q

What size do lung tumours have to be to be classed as stage 1 NSCLC?

A

Less than 5cm

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23
Q

At what stage NSCLC are contralateral hilar nodes present?

A

Stage IIIb (N3)

24
Q

What form of chemotherapy is favoured in metastatic NSCLC that is driver mutation negative?

A

Platinum containing doublet - cisplatin or carboplatin plus another

25
What is the classic phenotype of those with EGFR mutation negative NSCLC?
Non-smokers Female Asian Adenocarcinoma
26
Which lung cancer type is most closely associated with smoking?
Small cell
27
For patients with unresectable, stage III NSCLC whose disease has not progressed following concurrent platinum-based chemotherapy and RT, what agent may improve survival?
PD-L1 antibody Durvalumab, irrespective of PD-L1 expression As per PACIFIC trial
28
Which lung cancer type is most associated with hypercalcaemia? What is the common mechanism?
Squamous cell carcinoma PTHrP release by cancer
29
Which paraneoplastic syndromes are most common with SCLC?
SIADH Neurological e.g. Lambert-Eaton, peripheral neuropathy
30
Which type of cancer is most common in Australia (aside from non-melanomatous skin cancers)?
Breast cancer
31
What is the strongest prognostic factor in breast cancer?
Lymph node involvement
32
What does "grade" refer to in cancer?
The degree of cellular atypia
33
What is the prognostic relevance of age in breast cancer?
Younger age confers poorer prognosis
34
What is the risk factor most associated with chemotherapy-induced amenorrhea?
Increasing age
35
Which form of metastatic breast cancer has the worst prognosis?
Triple negative
36
In what kind of cancers are CDK4/6 inhibitors used?
Hormone receptor positive, HER2 negative metastatic breast cancers
37
Which BRCA gene is more associated with pancreatic cancer?
BRCA 2
38
Which BRCA gene is more associated with prostate cancer?
BRCA 2
39
What is the deal with tamoxifen and CYP2D6?
Requires the enzyme to be converted to active form Thus antidepressants that inhibit enzyme result in less efficacy of tamoxifen
40
Which electrolyte is decreased in TLS?
Calcium
41
What is the option for adjuvant treatment in Stage 2 CRC with high risk features?
Single agent 5FU or capecitabine
42
What is the usual adjuvant Rx for Stage 3 CRC?
Single or double agent chemo for 3-6 months depending on risk - FOLFOX - CAPOX
43
Best option for widely metastatic CRC that is R) sided?
Chemo - FOLFOX/FOLFIRI/CAPOX Can do triplet of FOLFOXIRI if good performance status + Bevacizumab
44
When can EGFR inhibitors be used in CRC?
Metastatic disease, L) sided primary KRAS / BRAF wild-type **If KRAS wild-type, EGFR mutant in advanced disease -> can consider BRAF/MEK/EGFR blockade
45
When are PD-1 inhibitors used in CRC?
Metastatic CRC that is MSI high or MMR deficient, that have progressed on chemotx
46
What is the difference between Goserelin and Degarelix?
Goserelin -> GnRH agonist - can initially stimulate sudden surge in T = "flare response, need to cover with testosterone antagonist for first week e.g. Bicalutamide Degarelix -> GnRH antagonist (avoids flare response)
47
What is done to the ADT in prostate cancer that has become castrate-resistant?
Generally continued, as it may slow progression
48
What is the ideal 1st line treatment for metastatic castrate-sensitive prostate cancer?
Aggressive upfront treatment -> | ADT + chemotherapy with docetaxel + abiraterone
49
What is the general treatment for metastatic castrate-resistant prostate cancer?
Continue ADT Many options: - chemo with taxane if fit enough - unfit or progressed on chemo -> Abiraterone or Enzalutamide
50
How does abiraterone work? AEs?
Androgen biosynthesis inhibitor -> inhibits CYP17 gene products, including 17-alpha-hydroxylase AE: HTN + Hypokalaemia (overproduction of aldosterone) Should be co-administered with prednisolone (as cortisol synthesis also blocked) LFT derangement
51
How does enzalutamide work? AEs?
AR antagonist. Inhibits binding of androgens to receptor AEs: HTN, fatigue, may increase risk of seizures (contraindication in hx seizures), cognitive impairment
52
How does tamoxifen work?
Selective oestrogen receptor modulator, may act as agonist or antagonist depending on target organ - antagonistic in breast cancer and breast tissue, as well as brain - agonistic effects in bone, liver, and uterus - Improves BMD and cholesterol AEs: Headache, hot flushes (Rx venlafaxine), fluid retention, genitourinary Sx, small ↑ risk of thromboembolic events Small ↑ risk endometrial cancer (in postmenopausal women)
53
How do aromatase inhibitors work?
Inhibits peripheral conversion of androgens to oestrogens - More effective than tamoxifen in post-menopausal women where oestrogen production occurs outside of ovaries in peripheral tissues - Can only be used in premenopausal women in combination with ovarian suppression, as it does only works peripherally AEs: MENOPAUSE -> N&V, headaches, hot flushes, fluid retention, genitourinary Sx, hyperlipidaemia - Joint pain and stiffness, vaginal dryness, accelerated BMD loss - More CVD / increased chol / DM compared with tamoxifen
54
How do CDK4/6 inhibitors e.g. ribociclib work? AEs?
Prevents progression through the cell cycle, resulting in arrest at the G1 phase. Inhibit progression of cell cycle from G to S phase. AEs: neutropaenia (managed with cyclical dosing), QT prolongation, LFT derangement
55
Metastatic melanoma Rx - 1st line for.. - BRAF mutant? - BRAF wild-type?
BRAF mutant - - BRAF + MEK inhibition - dabrafenib + trametinib AEs: fever, rash, GI upset BRAF wild-type - - FIT -> Ipi (CTLA-4) + Nivo (PD1) - not fit for combo -> 1. Nivolumab 2. Pembro 3. Ipi

FRACP NOSH 2020 (18 decks)

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