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Oncology > Medical Oncology > Flashcards

Medical Oncology Flashcards

1
Q

Screening for average risk group - asymptomatic with no personal hx of CRC/UC or family hx

A

FOBT 2nd yearly age 50-74

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2
Q

Screening for moderately increased risk group - 1st deg relative w CRC & age<55 or
Two 1st/2nd deg relatives w CRC

A

Colonoscopy every 5 yrs from age 50 OR 10 years younger than age of 1st dx of bowel ca in family

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3
Q

Screening for patients with HNPCC

A

Colonoscopy 1-2 yearly from age 25

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4
Q

Gene & chromosome assoc w Familial adenomatous polyposis

A

loss of APC gene on chrom 5

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5
Q

Extracolonic features of FAP

A

gastric/duodenal polyps, desmoid, thyroid, brain tumours

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6
Q

Indication of colectomy in FAP

A
  • documented/suspected CRC
  • adenoma w high grade dysplasia
  • significant sx (GI bleed)
  • marked increase in polyp number
  • inability to survey colon due to multiple diminutive polyps
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7
Q

Mismatch repair genes associated with HNPCC

A

MLH1, MSH2, PMS2, MSH6

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8
Q

Amsterdam criteria (3:2:1) to identify patients at risk of HNPCC

A
  • 3 or more relatives w Lynch assoc Ca, one is a 1st deg relative
  • Lynch assoc ca involving at least 2 generations
  • 1 or more diagnosed before age 50
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9
Q

Lynch associated cancers

A
  • colorectal
  • endometrial
  • ovarian. stomach
  • hepatobiliary
  • TCC ureter, kidney
  • gastric, pancreas
  • brain
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10
Q

Role of folinic acid with 5FU in chemotx

A

increases 5FUs half-life

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11
Q

Surveillance for curatively treated CRC

A
  • colonoscopy: full colonoscopy at conclusion of tx (if haven’t had one) then at 3 years then 5 yrly
  • phy exam + CEA:: 3mthly for 3 yrs, then 6 mthly
  • CT CAP annually for 3 yrs
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12
Q

Which gene more associated with left-sided vs right-sided colorectal cancer? which tx to use?

A

Left - RAS wild type -> responds to EGFR inhibitor

Right - BRAF mutation - poorer prognosis - use bevacizumab

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13
Q

EGFR inhibitors used in RASwt

A

cetuximab, panitumumab

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14
Q

Difference between EGFR inhibitors used in RASwt & EGFR+ve in NSCLC

A

cetuximab, panitumumab target extracellular EGFR vs intracellular for erlotinib, gefitinib in NSCLC

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15
Q

Toxicities in EGFR inhibitors

A

acneiform rash, hypoMg/hypoCa, pneumonitis, diarrhoea, xerosis (dry skin), paronychia

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16
Q

SEs of Bevacizumab

A

HTN, wound breakdown, GI perforation, proteinuria, thromboembolic events

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17
Q

Ix in Carcinoid syndrome

A

urinary 5-HIAA, chromogranin-A (good use for disease progression f/up)

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18
Q

Tx for carcinoid syndrome

A

somatostatin analogues: octreotide (short-acting), lanreotide (long-acting)

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19
Q

When to use maintenance Olaparib in pancreatic ca

A

BRCA2 +ve

*olaparib = PARP inhibitor

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20
Q

Which patient group with colorectal cancer may benefit using PD1 inhibitor

A

MMR deficient mets CRC

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21
Q

Histology types of ovarian ca

A

Mucinous (usually mets from GI tract)
Endometroid
Clear cell
High grade serous

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22
Q

Which patient group with ovarian ca to test for BRCA1/2 in patients?

A

Age <70yo wt high-grade non-mucinous epithelial ovarian/ fallopian tube/prim peritoneal ca

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23
Q

Chemo tx regime for ovaria ca if:-

  • optimally debulked
  • suboptimally debulked/stage IV
  • stage III/IV with BRCA 1/2 mutant
A
  • optimally debulked -> IP chemo
  • suboptimally debulked/stage IV - carbo/taxol + bevacizumab
  • stage III/IV with BRCA 1/2 mutant - carbo/taxol then maintenance Olaparib
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24
Q

What does it mean by platinum resistant recurrent ovarian ca?

A

recurrence <6 months from last treatment

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25
Q

Risk factors of endometrial cancer

A 
unopposed oestrogen (nulliparity, early menarche, late menopause, obesity, PCOS [chronic anovulation], tamoxifen) age, Lynch syndrome
*OCP is protective
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26
Q

Tx of endometrial ca

A

TAHBSO +/- sentinel LN sampling + peritoneal ax +/-omental biopsies

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27
Q

Types of HPV related to cervical ca

A

16 & 18

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28
Q

Predictors of relapse in cervical ca

A

Uterine corpus & lymph node involvement

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29
Q

Tx regime for FIGO IB2- IVA cervical ca

A

definitive concurrent chemoradiation - cisplatin weekly + 50.4Gy whole pelvis radiotx + 12Gy brachytx

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30
Q

Palliative tx regime for metastatic cervical ca

A

Carboplatin/Paclitaxel + bevacizumab

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31
Q

gene mutation more likely related to breast ca in men & prostate ca

A

BRCA2

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32
Q

Syndrome associated with sarcomas, adrenal, brain ca with breast cancer risk >90%

A

Li-Fraumeni syndrome (TP53)

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33
Q

Syndrome & gene assoc w thyroid, endometrial, GU ca with breast cancer risk 25-50%

A

Cowden (PTEN)

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34
Q

Syndrome & gene assoc w benign hamartomatous polyps, hyperpigmented macules on oral mucosa with breast cancer risk 50%

A

Peutz-Jaghers syndrome (STK11/LKB1)

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35
Q

Cancers associated with Peutz-Jaghers syndrome

A 
Breast ca (50%)
small intestine
colorectal
sex cord tumours
uterine
testicular
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36
Q

Syndrome & gene a/w diffuse gastric ca

A

Hereditary diffuse gastric ca (CDH1)

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37
Q

Type of breast ca a/w hereditary diffuse gastric ca

A

lobular breast ca - 40% risk

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38
Q

Poor prognostic features of breast cancer

A 
\+ve axillary LN, 
increasing size, 
higher grade (higher % of Ki-67), 
ER/PR -ve, 
untreated HER2 overexpression, 
younger age, 
lymphovascular invasion
39
Q

subtypes of breast ca & respective tx regime

A
  • Luminal A (ER/PR +ve, low HER2) -> no chemo
  • Luminal B (weaker ER, higher HER2) -> consider chemotx
  • HER2 enriched -> chemo + trastuzumab
  • Triple -ve -> Chemotx
40
Q

Indications of mastectomy for breast ca

A
  • Multi-centric
  • Large tumour
  • Imaging concerns - diffuse malignant appearing calcifications
  • Prior chest RT
    Inflamm breast ca
41
Q

Risks of Tamoxifen (SERM)

A

ER antagonist on breast but agonist on bone & uterine

  • endometrial hyperplasia
  • VTE
42
Q

Risks of aromatose inhibitor e.g. anastrozole

A

Osteoporosis

43
Q

Risks of trastuzumab & what type monitoring is needed?

A

Reversible cardiac toxicity

Monitor LVEF 3 monthly

44
Q

Likely sites of mets for these advanced breast ca:-

  • ER+ve
  • HER2+ve
  • Triple -ve
A
  • ER+ve - bone & LN mets
  • HER2+ve - brain mets
  • Triple -ve - visceral mets
45
Q

Tx regime for HR+ve advanced breast ca

A

Palbociclib + fulvestant/aromatose inhibitor

46
Q

Mechanism of action & AEs of Palbociclib

A

CDK4/6 inhibitors - inhibition activates tumour suppressor retinoblastoma protein (pRB) & causes cycle cycle arrest

47
Q

Tx regime for Triple -ve Breast Ca

A

usually sequential single agent +/- atezolizumab (PD-L1 inhibitor)
Alternative: PARP inhibitor - Olaparib

48
Q

Which individuals with breast cancer should be considered for BRCA genetic testing

A
  • triple negative age<50
  • triple negative with 1st/2nd degree relative w breast/ovarian ca
  • age <40
49
Q

Syndrome & gene a/w cerebellar/spinal haemangiomas, retinal angioma & renal cell ca

A

von Hippel-Lindau syndrome (VHL gene)
*tumour suppressor gene on Chr3 -> loss of heterozygosity at vHL locus -> overproduction of VEGF -> role in tumour angiogenesis

50
Q

Tx regime for palliative intent mets RCC

A 
good prognosis: sunitinib/pazopanib
intermediate & poor-risk: Nivolumab + Ipilimumab
MTOR inhibitor(everolimus) is 2nd line
51
Q

Mechanism of action of Sunitinib

A

multikinase inhibitor: - Inhibits VEGF receptor TK, PDGF receptor & c-kit oncogene

52
Q

Adverse effects of Sunitinib

A

lethargy, HTN, stomatitis, hypothyroidism, hand-foot syndrome, hepatitis, neutropenia, thrombocytopenia, LV dysfunction

53
Q

1st & 2nd line Androgen deprivation therapy for metastatic prostate ca

A

1st line: GNRH agonist (Goserelin/Leuprorelin)
+ docetaxel (for high vol dx - 4 bone mets)
+ testosterone antagonist (bone mets)

2nd line: complete androgen blockage - GNRH agonist + testosterone antagonist (bicalutamide)

54
Q

Why is testosterone antagonist needed with GNRH agonist for prostate ca with bone mets

A

GNRH agonists acts as agonist for 1st 2 weeks before being antagonist; testosterone antagonist prevent growth of mets causing malignant pain & rarely spinal cord compression

55
Q

Treatment regime for castrate-resistant prostate ca

A
  • Total androgen blockade (GNRH agonist & Bicalutamide)
  • Docetaxel/Prednisolone
  • Enzalutamide
  • supportive tx - Zoledronate/Denosumab
56
Q

Mechanism of action & SEs of Docetaxel

A
  • Taxane -> inhibits disassembly of microtubules during cell cycle -> inhibits cell division. Inactivates bcl-2 ->apoptosis
  • SE: alopecia, n&v, pancytopenia, fluid retention, peripheral neuropathy
57
Q

Mechanism of action of Abiraterone

A

blocks synthesis of testosterone in adrenal gland

58
Q

Contraindication of Abiraterone

A

cardiac dx & avoid in diabetes as need prednisolone (causes adrenal insufficiency)

59
Q

Mechanism of action & contraindication of Enzalutamide

A
  • Androgen receptor antagonist

- Avoid pts w neurological cdtns (e.g. epilepsy), memory/cognitive impairment

60
Q

which type of testicular cancer has elevated HCG but normal AFP?

A

seminoma, choriocarcinoma

61
Q

which type of non-seminoma testicular cancer has very elevated AFP?

A

yolk-sac tumor

62
Q

Markers of poor prognosis in testicular cancer

A

AFP >10k
bHGC >50k
LDH >10x ULN

63
Q

Chemotx for metastatic testicular ca

A

BEP - bleomycin/etop/cisp

Cisplatin-resistant (relapse within 4 weeks) - VIP (vinblastine, ifosfamide, cisplatin/TIP

64
Q

Significant predictors of melanoma

A

Breslow depth of lesion & presence of ulceration

65
Q

Types of melanoma

A

Radial growth phase: superficial spreading, lentigo maligna, acral lentiginous
Vertical growth phase: Nodular

66
Q

Type of melanoma a/w intermittent sun exposure

A

Superficial Spreading Melanoma

67
Q

Type of melanoma a/w large amounts of cumulative UV exposure

A

Lentigo Maligna (Hutchinson’s Melanotic Freckle)

68
Q

Type of melanoma accounts for almost all in Africans & most in Asians

A

Acral lentiginous

69
Q

Adjuvant tx for stage 3B/C/D & 4 of melanoma

A
  • Dabrafenib & Trametinib for BRAF mutation

- Nivolumab/Pembro regardless of PDL1 expression or BRAF mutation

70
Q

Mechanism of action of Dabrafenib & Trametinib

A

BRAF & MEK inhibition

71
Q

gene mutation related to intermittent sun exposure

A

BRAF

72
Q

gene mutation related to chronic sun exposure

A

KIT, CDK4

73
Q

gene mutation related to acral exposure

A

NRAS, KIT

74
Q

Adverse effects of Dabrafenib

A

Pyrexia, hyperkeratosis, arthralgia, rash, keratoacanthoma, squamous cell ca, hyperglycaemia

75
Q

Difference between Dabrafenib vs Vemurafenib vs Encorafenib

A

Vemurafenib - no CNS activity Encorafenib - less pyrexia rate

76
Q

When is Imatinib used melanoma?

A

patient with KIT mutation

77
Q

Definition of limited stage small cell lung ca

A

All disease within one radiation field (ipsi lung & hilar/mediastinal LN)

78
Q

Examples of EGFR & ALK inhibitors

A

EGFR inhibitors - Gefitinib, erlotinib, afatinib

ALK inhibitors - Crizotinib, Alectinib

79
Q

When is Osimertinib used?

A

EGFR mutation with T790M resistance mutation in NSCLC

80
Q

When to use single agent PD(L)1 inhibitor in NSCLC

A

> 50% PD-L1 expression

81
Q

Examples of PD-1 inhibitors & PD-L1 inhibitors

A

PD-1 inhibitors: Nivolumab, Pembrolizumab

PD-L1 inhibitors: Atezolizumab, Avelumab, Durvalumab

82
Q

Histological types of mesothelioma

A

Epithelioid & sarcomatoid (poorer prog)

83
Q

Difference between Alectinib & Ceritinib from Crizotinib as ALK inhibitor

A

Alectinib & Ceritinib have good CNS penetration

84
Q

Screening recommendation for HNPCC carrier patient

A

annually or 2 yearly with colonoscopy around the age 25 or 5 years before youngest family member diagnosed with cancer

85
Q

What is the upfront treatment for acneiform rash caused by EGFR antibodies?

A

moisturizer, doxycycline and topical steroid

86
Q

Toxicities of 5-FU, Capecitabine

A
  • Mucositis
  • Diarrhoea
  • Plantar-palmar erythrodysesthesia (Hand-foot syndrome) - Capecitabine >5-FU
87
Q

Which patient group tx with 5 F-U/capecitabine has higher risk of myelosuppression & mucositis?

A

dihydropyrimidine dehydrogenase deficiency in 2-8% population

88
Q

Difference between prognostic vs predictive markers

A

Prognostic markers - info on outcome, independent of therapy

Predictive markers - info on outcome with regards to a specific therapy

89
Q

Most common site of spine causing spinal cord compression

A

Thoracic - 60%

- lumbar 25%, cervical 15%

90
Q

What is founder effect?

A

high frequency of specific gene mutation in a population founded by a small ancestral group

91
Q

Screening for BRCA1/2, PALB2 mutation carrier

A
  • Breast Screening to commence at age 25yrs
  • Risk reducing BSO from 40yrs
    Or 5 years earlier than the youngest person affected
92
Q

Screening for Lynch Syndrome

A
  • MHL1/ MSH2: Screening colonoscopy from 25yrs
  • PMS2/ MSH6: Screening colonoscopy from 30yrs
  • Risk reducing TAHBSO from 40 yrs
    Or 5 years earlier than the youngest impacted
93
Q

Screening for FAP

A

Screening colonoscopies from 12yrs Or 18 yrs in AFAP until colectomy

94
Q

Screening for VHL gene mutation carrier

A
  • Annual exam with BP from 2 yrs
  • Annual plasma or urine metanephrine screening from 2yrs
  • Annual abdominal screening Alternating US/ MRI from 10yrs

Oncology (1 decks)

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