MRCP Oncology Flashcards
Thyroid cancer diagnosed by…
Fine needle aspiration of thyroid nodule
Small cell lung cancer paraneoplastic syndromes
SMAA
ADH
ACTH
Squamous cell lung ca paraneoplastic syndrome
PTH
Bronchial carcinoma paraneoplastic syndrome
Carcinoid syndrome
Which lung cancer is not associated with smoking
Adenocarcinoma
What is the most common deaths due to cancer in men top 3
- lung
- prostate
- colon
What is the most common deaths due to cancer in women top 3
- lung
- breast
- colon
Which rheumatological condition is associated with cancer
dermatomyositis
What is the management of bladder cancer
No metastasis (local no lymph node/muscle invasion)
- TURBT with single mytomicin C
- Follow up cystoscopy in 3 and 12 months
Which cancer is hep B/C associated with
HCC
facial swelling,
distended neck vein,
upper limb oedema,
distended veins in anterior chest wall
SVC obstruction due to lung cancer
What is MESNA (sodium 2-mercapto ethanesulfonate)
detoxify urotoxic chemotherapy
- ifosfamide
- cyclophosphamide
NF type 2 bilateral cancer…
acoustic neuroma
chr 22
Neutropenic sepsis
fever
low BP
tachycardia
urgent abx and cultures
Which leukaemia is assocaited with RAR alfa mutation on Chr 17
- acute pro-myelocytic leukaemia (AML subtype)
- translocation between chr 15 and 17
- forms PML-RAR alfa –> block myeloid differentiation
- treat with all trans retinoic acid (ATRA)
Virus and cancer associations
EBV- burkitt and hodgkins
Hep B- HCC
HHV-8 - kaposi
HPV 16,18 - cervical, anal, oropharyngeal
Human T lymphocyte - leukaemia
What mutation if papillary thyroid carcinoma associated with
RET prto-ongogene for tyrosine kinase mutation
testicular lump, CXR mass, raised beta hcg
testicular seminoma
Tumour lysis syndrome hallmarks
treatment of high grade lymphoma and leukaemia
triggered by R-CHOP combination
- breakdown of tumour cells –> release cell content –> high potassium high phosphate low calcium
Present: AKI, high phosphate, high uric acid
What medication lowers incidence of Tumour lysis syndrome
allopurinol
Lung cancer with back pain and bilateral leg weakness suddenly,…
spinal cord compression due to spinal mets
what are negative acute phase proteins
- decreases during inflammation
albumin
transferrin
antithrombin
Which cancers are tyrosine kinase inhibitors effective in?
- CML (philadelphia chromosome 9:22, BCR-ABL tyrosine kinase inhibitor)
- GIST - kit inhibitor
imatinib
Myeloma blood test shows…
anaemia
thrombocytopenia
high IgG
monoclonal bands on electrophoresis
hypercalcaemia
Transitional cell tumours associated with…
smoking
rubber/chemical industry
phenacetin
Squamous cell carcinoma bladder cancer
schistosomiasis chronic inflammation
Courvoisier’s law
malignant obstruction below level of cystic duct-> palpable distended GB
a painless, enlarged gallbladder with jaundice is unlikely to be caused by gallstones
more likely to be caused by a malignant obstruction of the bile duct, such as pancreatic cancer or bile duct cancer
monoclonal ab against CD20 example
rituximab
- used in CLL
itchy and tender acanthosis nigracans associated with…
malignancy
What is the action of imatinib
tyrosine kinase inhibitor
in GIST- KIT inhibitor for stem cell
First line investigation for women >50 with ascites, palpable mass in iliac fossa and raised CA125
US abdo pelvis —> CT staging and biopsy
?ovarian cancer
Ovarian cancer symptoms
abdo distension
early satiety bloating
frequent UTI
weight loss
palpable abdo mass
Thyroid cancer epidemiology
Papillary (80-85%) - papillary popular
follicular (5-10%) - followed by…
medullary rare
anaplastic rare
Which thyroid cancer produced calcitonin
medullary
Which serum marker gives early detection of recurrent papillary and follicular thyroid cancer
thyroglobulin
Phase 1-4 of human trial
1- human toxicity
2- efficacy of drug
3- compare to current drug
4- long term toxicity
first line treatment for symptoms for carcinoid syndrome
octreotide
somatostatin analogue blocks 5-HT
Bone mets blood film
leucoerythroblastic blood film
- immature RBC
MSCC treatment
dexamethasone
Pancost tumour
pain in shoulder
brachial plexus involved
weakness and atrophy of hand
Horner syndrome
hoarsness
T1-2 cord compression
Syringomyelia
weakness and wasting of upper limb
loss of sensation of pain
sparing touch and proprioception
areflexia in arms
spastic paraparesis
cape pattern
Investigation for myeloma
First:
- serum electrophoresis
- urine electrophoresis (bence protein)
- serum free light chains (paraprotein)
Note: bone marrow biopsy needed if above -ve to confirm monoclonal plasma cells
Cryoglobinaemia hallmarks
raynauds in type 1
underlying lymphoma
cryoglobulin precipitate when serum incubated at 4 degrees
raynaud symptoms in cold due to precipitation
Osmotic fragility test…
hereditary spherocytosis
Cerebral mets with oedema management
dexamethasone
+/- IV mannitol to reduce cerebral oedema
Best diagnostic test for CLL
flow cytometry
- analyse cell surface markers on leukocytes aka B clonal cells
- non invasive method
Common site of neuroendocrine tumour
ileum
carcinoid tumour –> serotonin
What is the most important thing about screening cancer method
clinically effective and cost effective method of early treatment
Febrile neutrophilia commonest organism
staph epidermidis
strep viridans
Treatment of choice for SVCO
radiotherapy
Clear cell renal adenocarcinoma
hypernephroma causing left varicocele
Triad:
haematuria
loin pain
abdo mass
Why is left varicocele seen
compression of left renal vein (drains)
Platelet transfusion in unwell patient
aim plt above 20
Burkitt’s lymphoma hallmarks
B cell lymphoma
EBV related
translocation (8;14)
results in c-myc protooncogene transposition
leading to dysregulated cell proliferation
STARRY SKY appearance (macrophage phagocytosin cell debris and apoptotic cells scattered)
Anaplastic thryoid cancer sequelae
rarest
cervical lymph node mets in 90%
lung mets and tracheal deviation
VERY POOR PROGNOSIS
UPPER AIRWAY OBSTRUCTION
What is residual tumour classification for colon cancer
RX - cannot assess
R0- no residual tumour
R1- microscopic residual
R2- macroscopic residual
TNM stands for
tumour size
lymph node
metastasis
Treatment for resectable oesophageal cancer
chemo preop
then surgery
stent if dysphagic.
Cellcycle
G0 - rest
G1- ready to divide
S - DNA copied
G2 - just before mitosis
M - mitosis
Note: chemotherapy does not affect G0 phase
Prolactinoma management
medical management with cabergoline/bromocriptine
surgical if significant mass effect or refractory case
Most common cancers with bone mets
bronchial
breast
prostate
Which Tumour marker is sensitive to bronchial carcinoid
chromogranin A
Note: neuron specific enolase also seen
Risk factors for oesophageal adenocarcinoma
GORD (strongest)
Obesity
Barrett’s
Smoking
Poor Diet
Oesophageal cancer location
Adenocarcinoma:
Lower third - near the gastroesophageal junction
SCC:
Upper two-thirds of the oesophagus
Risk factor for oesophageal SCC
smoking
alcohol
achalasia
Plummer-Vinson syndrome
diets rich in nitrosamines
SCC skin hallmarks
scaly crusty skin
red inflamed base
UV exposed areas
areas of bowmen disease/chronic leg ulcer
risk: immunosuppression/organ transplant
metastasis via lymphatic channels
Anti yo associated with…
breast/ovarian/endometrial/fallopian ca
- paraneoplastic cerebellar degeneration
- tumour express protein triggering autoimmune rx
- dysarthria, ataxia, nystagmus
Anti hu associated with…
small cell lung cancer
First line treatment for hodgkins lymphoma
combines chemo and radiotherapy
- ABVD
(adriamycin, bleomycin, vinblastine, decarbazine)
MEN 1 genetics
autosomal dominant
- pituitary
- parathyroid
- pancreas
When is CEA useful
post op surveillance
HCC hallmarks
most common primary hepatic tumour
more common in asia and africa due to hep B/C/aflotoxin
AFP tumour marker
Most rapidly progressing lung cancer
small cell lung cancer
Mechanism of action of cisplatin
cross linking in DNA
side effects:
- nephrotoxic
- neurotoxic
- ototoxic
- low Mg K Ca
HCC tumour size amenable to liver transplant
<5 CM
<3 CM X 3
No extrahepatic or major vessel
Chemotherapy for colorectal cancer
FOLFOX and FOLFIRI
folic
flurouracil
oxaliplatin
apple green bifringence under polarised light after congo red staining
myltiple myeloma
Small cell lung cancer chemotherapy
cisplatin
etoposide
Non small cell lung cancer chemotherapy
Carboplatin
paclitaxel
CA 153
Breast cancer
Renal tumour management
partial or total nephrectomy
tumour <7cm - partial
Neurological paraneoplastic disease
encephalistis
myelopathy
neuropathy
myopathy
cerebellar degeneration
eaton lambert syndrome
Paraneoplastic syndromes
Paraneoplastic neutrophilia
SIADH
dermatomyositis
acanthosis nigracans
polycythaemia
PUO
Aromatic amines cause…
Bladder cancer
Best investigation for bone metastasuis
Bone scintigraphy
Reed steinburg is associated with..
Hodgkins disease
Dukes criteria for colorectal cancer
Stage A
- confined to bowel
Stage B
- full thickness of bowel wall into serosa
Stage C
- spread to tumour to draining lymph nodes
Stage D
- distant spread primarily to liver
Colorectal stage D management
5-FU with folinic acid
HNPCC (lynch) sydrome associated with…
CEO
colorectal
endometrial
ovarian
