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CCC > Onc-General Principles > Flashcards

Onc-General Principles Flashcards

1
Q

Explain the values for T in TNM staging:

A

TX - Primary tumour cannot be assessed
TO - No evidence of primary tumour
Tis - Carcinoma in situ
TI, T2, T3, T4 - Increasing size and/or local extent of the primary tumour

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2
Q

Explain the values for N in TNM staging:

A

NX - Regional lymph nodes cannot be assessed
NO - No regional lymph node metastasis
NI, N2, N3 - Increasing involvement of regional lymph nodes

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3
Q

Explain the values for M in TNM staging:

A

MX - Presence of distant metastasis cannot be assessed
M0 - No distant metastasis
M1 - Distant metastasis

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4
Q

Explaining Grading of a tumour:

A

GX - Grade of differentiation cannot be assessed
G1 - Well differentiated: Similarities remain to normal tissue of the organ of origin
G2 - Moderately differentiated
G3 - Poorly differentiated: bizarre cells

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5
Q

What is the The RECIST system?

A 
A measure of response to treatment: 
Complete Response (CR): Non detectable
Partial Response (PR): Shrunk >30%
Stable Disease (SD): between + 20% and - 30%
Progressive Disease (PD): > +20% or new lesions
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6
Q

RECIST rank of ‘‘All lesions have shrunk by at least 30%, but disease still present’’

A

Partial response

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7
Q

RECIST rank of ‘‘New lesions or lesions that have increased in size by more than 20%’’

A

Progressive disease

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8
Q

RECIST rank of ‘‘Less than 20% increase in size or less than 30% decrease in size’’

A

Stable disease

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9
Q

What radioisotope is commonly used in PET scans?

A

FDG-18

fluorine 18 is a radioactive form of glucose

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10
Q

What is the principal investigation for detection of skeletal metastases?

A

Bone scintography (Bone scan)

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11
Q

CEA is a tumour marker commonly used in the monitoring of what cancer?

A

colorectal carcinoma

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12
Q

CA125 is a tumour marker commonly used to help in the diagnosis what cancer?

A

Ovarian cancer

A level greater than 200U /ml is definitely malignant

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13
Q

Where is Alpha Fetoprotein (αFP) normally produced?

A

In the normal foetal yolk sac, liver and intestines

It is undetectable in normal individuals after the first year of life.

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14
Q

What non malignant condition can cause a moderate rise in Alpha Fetoprotein (αFP)?

A

Hepatitis

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15
Q

What are high levels of Alpha Fetoprotein (αFP) associated with?

A

Hepatocellular carcinoma

Cancers containing yolk sac elements (e.g. teratoma).

High levels of αFP predict a poor prognosis in malignancy

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16
Q

What malignant disease causes a specific elevation of the β-subunit of Human Chorionic Gonadotrophin (HCG)?

A

non-seminomatous testicular cancers

and some with seminoma

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17
Q

What are the four broad types of surgical biopsy?

A

Fine needle aspiration cytology
Tru-cut needle biopsy - a piece is sampled under local anaesthetic
Incisional biopsy- a piece is sampled at surgery
Excisional biopsy- the whole of a mass is removed

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18
Q

What are the indications for chemotherapy?

A 
Neoadjuvant 
Primary
Adjuvant
Palliative
Curative
Prophylactic
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19
Q

What is neoadjuvant chemotherapy?

A

Pre-operative treatment of an operable tumour before definitive surgical intervention.

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20
Q

What is Primary chemotherapy?

A

Initial chemotherapy for a tumour that is inoperable or of uncertain operability, where a reduction in the tumour bulk in a pre-defined manner may make surgery with curative intent feasible

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21
Q

What is adjuvant chemotherapy?

A

The use of chemotherapy following a complete macroscopic clearance at surgery

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22
Q

What is palliative chemotherapy?

A

Treatment to alleviate symptoms and in some cases prolong life in patients who cannot be cured.

23
Q

When is curative chemotherapy used?

A

When there is a real chance of a cure even if there is metastatic disease at presentation (e.g. germ cell tumours, Hodgkin’s disease, Non-Hodgkin’s lymphoma and many childhood cancers)

24
Q

When might prophylactic chemotherapy be used?

A

Hormonal treatments may be given before overt malignancy appears. For instance tamoxifen may be used for in-situ breast cancer before invasive carcinoma is recognised.

25
Q

How are chemotherapy doses calculated?

A

Usually to body surface area
- using the DuBois and DuBois

Some on Renal function - eg. Carboplatin
Some on body weight

26
Q

Why are chemotherapy drugs given in combination?

A

Maximise tumour cell kill
Minimise toxicity to non-tumour cells
Minimise the development of resistance

27
Q

What defines High dose chemotherapy?

A

High dose chemotherapy refers to the use of chemotherapy agents at doses that require bone-marrow support - achieved by bone-marrow transplantation or peripheral haematopoietic progenitors (stem cells)

28
Q

What are common immediate complications of chemotherapy?

A 
Nausea & Vomiting 
Myelosuppression 
GI - mucositis 
Alopecia
Neuropathies and ototoxicity  
Nephrotoxicity 
Soft tissue - Extravasation
29
Q

What are common long term complications of chemotherapy?

A 
Secondary Malignancy 
Reduced fertility 
Pulmonary fibrosis 
Cardiac fibrosis
Psychological and Social
30
Q

When does the nadir of myelosuppression most often occur ?

A

10 - 12 days after chemo

31
Q

What targeted chemotherapy drugs end in -mab

A

Monoclonal antibodies
- all given as intravenous infusions.

e.g. trastuzumab (Herceptin) used in breast cancer adjuvant and metastatic treatment for patients with HER2+ disease

32
Q

What targeted chemotherapy drugs end in -ib

A

Tyrosine kinase inhibitors

e.g. sunitinib (Sutent) anti-VEGFR (vascular endothelial growth factor receptor)

33
Q

What targeted chemotherapy drugs end -us

A

mTor inhibitors
- (mammalian target of rapamycin)

e.g. everolimus (Afinitor), an oral serine/threonine kinase inhibitor

34
Q

How are doses of radiotherapy delivered by a linear accelerator administored and measured?

A

unit = gray (Gy)

administered in fractions
e.g. 70Gy in 35 fractions over 7 weeks

35
Q

Describe the pre treatment phase of the radiotherapy treatment process:

A
  1. Diagnosis and Imaging
  2. Discussion at an MDT
  3. Patient consents to radiotherapy
  4. Patient immobilisation
  5. Planning CT performed
36
Q

Describe the planning phase of the radiotherapy treatment process:

A
  1. Disease delineation by clinical oncologist
  2. Additional margins added for microscopic disease
  3. Complex treatment plans developed
37
Q

Describe the delivery phase of the radiotherapy treatment process:

A
  1. Patient attends for daily fractions
  2. Treatment delivery and verification monitored daily radiographers
  3. Clinical review by clinical oncologist
  4. Long term follow up
38
Q

What are common acute side effects of radiotherapy?

A

Lethargy
Localised skin reaction,
Oral mucositis
Diarrhoea.

39
Q

What is Intracavity brachytherapy?

A

the radioactive material is placed inside a body cavity such as the uterus and cervix

40
Q

What is Interstitial brachytherapy

A

where the material is put into the target, such as the prostate

41
Q

What is radioactive iodine, I-131 used in the treatment of?

A

the most common forms of thyroid cancer

42
Q

Describe Phase 1 of a clinical trial:

A

Aim is to determine toxicity (previously tested in vitro and in animals) and establish the maximum tolerated dose (MTD). Dose escalation is performed, commencing at 10% of the dose (/kg!) that is lethal in 10% of mice (‘LD10’).
Phase I trials are performed on patients with any tumour, in whom no conventional therapy is appropriate

43
Q

Describe Phase 2 of a clinical trial:

A

Aim is to assess the particular anti-tumour activity of a new treatment in a range of different cancers. The radiological tumour shrinkage (‘response rate’) is the primary outcome measure. Does not require a control arm, though may be helpful.

44
Q

Describe Phase 3 of a clinical trial:

A

Randomised trials comparing new with established treatments. Primary endpoints assessed are usually length of life whatever the cause of death (‘overall survival), or length of life until the cancer grows (Progression-free survival). Need statistically significant results so often large trails.

45
Q

Medical Outcome Study (MOS) and Short Form (SF)-36 are example of what?

A

Generic quality of life questionnaires

46
Q

EORTC, Core-30 and the ‘FACT’ are an example of what?

A

Cancer specific quality of life questionnaires

47
Q

What does QTWIST stand for?

A

quality of time without symptoms or treatment side effects

48
Q

What is a QALY?

A

a quality adjusted life year

49
Q

What can The HAD scale be used for?

A

Hospital Anxiety and Depression scale

- for screening for psychiatric morbidity in inpatients

50
Q

What is the Rotterdam checklist?

A

for screening for depression and anxiety in cancer patients

51
Q

When is cervical cancer screening offered?

A

All women aged between 25 and 64

Women aged 25 to 49 are invited every three years.
After that they are invited every five years.

52
Q

When is mammography for breast cancer screening offered?

A

All women between the ages of 50 and 70 every 3 years

53
Q

When is faecal occult sample screening offered?

A

Men and Women

Every two years from 60 to 74

CCC (5 decks)

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