Miscellaneous & Side Effects

Question 1

In which two types of malignancy is ANY positive lymph node involvement considered Stage IV?

Answer 1

Bladder

Prostate

Question 2

What are the malignancies that commonly cause osteoblastic bone metastases (4)?

Answer 2

Prostate
Small-cell lung cancer
Carcinoid
Hodgkin lymphoma

Question 3

What are the malignancies that are known to cause osteolytic bone metastases (6)?

Answer 3

Multiple myeloma
NSCLC
RCC
Melanoma
Thyroid cancer
Non-Hodgkin lymphoma

Question 4

Which malignancies are known to cause mixed osteoblastic/osteolytic bone metastases?

Answer 4

Breast
GI
Squamous cell carcinomas (NSCLC, H&N, cervical CA)

Question 5

Which malignancies are resistant to radiation (3)?

Answer 5

RCC
Osteosarcoma
Melanoma

Question 6

Which malignancies metastasize to the right supraclavicular node?

Answer 6

Lung

Esophageal

Question 7

Which malignancies metastasize to the left supraclavicular node?

Answer 7

Virchow’s Node

• Abdominal/GU malignancies via the thoracic duct (gastric, gallbladder, pancreas, kidneys, testicles, ovaries, prostate)
• Ipsilateral breast
• Ipsilateral lung

Question 8

Which malignancies metastasize to the umbilical nodes?

Answer 8

GI - gastric, colon, pancrea
Gyne - ovarian, endometrial
Unknown primary

Question 9

What are the common side effects of platinum chemotherapy?

Answer 9

All: peripheral neuropathy
Cisplatin-specific: highly emetogenic, nephrotoxic, ototoxic, hypoMg/Ca/K
Oxaliplatin-specific: Cold-induced neuropathy

Question 10

What are the toxic effects of cyclophosphamide?

Answer 10

• Emetogenic
• Hemorrhagic Cystitis
• Secondary malignancies (MDS, AML, bladder CA)
• Infertility

Question 11

What are the important side effects of anti-metabolite agents (ex. 5-FU)? (4)

Answer 11

Diarrhea
Mucositis
Hand-Foot Syndrome
Coronary Vasospasm

Question 12

What are the anti-metabolite agents commonly used in malignancy treatment?

Answer 12

5-fluorouracil

Capecitabine

Question 13

What are the topoisomerase inhibitors commonly used in cancer treatment?

Answer 13

Irinotecan

Etoposide

Question 14

What are the important side effects of anti-angiogenesis/VEGF inhibitors (ex. Bevacizmab)? (5)

Answer 14

HTN
Bleeding
Bowel perforation
Delayed wound healing
Arterial thromboembolism (CVA/MI)

Question 15

What chemotherapeutic regimens are considered highly emetogenic? (2).

Answer 15

1. CISPLATIN

2. Anthracycline/cyclophosphamide combination

Question 16

How would you treat a highly emetogenic chemotherapy regimen?

Answer 16

1. NH1-receptor antagonist (aprepitant)
2. 5-HT3 anatagonists (ondansetron)
3. Steroid (dexamethasone)
4. 5-H2/D2 antagonist (olanzipine)

Question 17

Which therapy may increase EPO efficacy in cancer patients?

Answer 17

Iron supplementation

Question 18

What is their recommendation for chemo-associated anemia and EPO?

Answer 18

DO NOT use EPO if intent is curative.

Consider if palliative intent.

Question 19

What tumour marker is important in malignant melanoma?

Answer 19

BRAF mutation

Question 20

What are the side effects of vincristine?

Answer 20

Peripheral Neuropathy

Question 21

What are the side effects of tyrosine-kinase inhibitors(5)?

Answer 21

HTN
Bleeding
Hand-foot skin reaction
Diarrhea
Mucositis

Question 22

List two examples of tyrosine kinase inhibitors.

Answer 22

Sunitinib

Sorefenib