Onc / palliative Flashcards
Side effect long term amiodarone
Hepato / pulm fibrosis
Hyper/Hypo thyroid
Corneal deposits
Pancreatitis
Long QT
supraclavicular fossa lymph node usually which tumour
Gastric
[Virchow’s node and
Infection assoc with 1/3 gastric tumours
H pylori
Metastatic gastic adenoma. What testing do you do? What is treatment if this is positive
HER2
[human epidermal growth factor receptor 2]
Trastuzumab
What is Zollinger-Ellison syndrome? Which syndrome are they linked to? Main symptoms ?
Gastrin secreting tumours -> gastric / duodenal ulceration
[Usually pancreatic in origin]
MEN1
Epigastric pain
Steatorrhoea (acid-related inactivation of digestive enzymes)
Diarrhoea - From acid secretion
Zollinger-Ellison syndrome - high serum gastrin levels and elevated basal gastric acid output.
Main Ix? 2 parts of medical RX?
Endoscopy + CT
High dose PPI
Surgical resection ( in most)
chemo
Somatostatin analogues - Eg Ocretide to reduce gastric secretion and diarrhoea
acrocyanosis
Blue discolouration of hands - especially when in cold
Poikilocytosis
Abnormal shape RBCs (making up >10%)
What is cryoglobulinemia? Conditions assoc? Ix?
abnormal blood proteins called cryoglobulins clump together at cold temperatures
Seen in myeloma / leukaemia / lymphoma
-Some infections too Eg HepC, HIV, toxoplasmosis, EBV, malaria
Incubate serum at 4°C
Some less common cancer markers…
Neurone specific enolase NSE
Small cell lung Ca
Neuroblastoma
Some less common cancer markers…
HCG
Testis
Some less common cancer markers…
Calcitonin
Medullary thyroid
Some less common cancer markers…
Parathormone
Parathyroid
Some less common cancer markers…
IgG, IgA, IgM, IgE
Multiple myeloma
Some less common cancer markers…
AFP - name 2
Liver
Testis
Yolk sac
Some less common cancer markers…
Ca 15-3
Breast
Bowel
Lung
how does late chemo toxicity usually present
Peripheral neuropathy
Ototoxicity
why do 5% of testis Ca have gynaecomastia
Tumour secretes HCG
Enzyme sometimes used for seminoma marker
PLAP
Placental alkaline phosphatase
2 main classes of testis Ca
-Seminoma
-Non-semonomas germ cell tumour (NSGCT)
Eg Yolk sac, teratoma, choriocarcinoma, embryonal
80% cure of testis Ca with orchidectomy.
What is offered to reduce the risk of relapse
Single dose carboplatin
Who gets resection of HCC? Transplant?
Need Childs-pugh class A for resection
[still 20% operative mortality]
Transplant
-Single tumour <5cm with no metastatic spread
-AFP <1000iu/ml
Which lung Ca usually has Mets at presentation
Small cell
Which lung Ca is usually more peripheral
Adenocarcinoma
General differentiation between lung mets and primary lung Ca on CT
Primary - soft tissue mass with irregular borders
Met - smooth and rounded
Paraneoplastic syndromes which lung Ca ?
Hypovolaemic hyponatraemia
Raised ACTH
Hyper Ca
Gynaecomastia
Hyperthyroid
Lambert-eaton
Hypertrophic pulmonary osteoarthropathy
Hypovolaemic hyponatraemia - SIADH = small cell
Raised ACTH - Small cell
Hyper Ca - Squamous - from bony mets [rarely produces PTH too)
Gynaecomastia - Large cell (large breasts) and adenocarcinoma
Hyperthyroid - Squamous (produces TSH)
Lambert-eaton - Small cell
Hypertrophic pulmonary osteoarthropathy - Adenocarcinoma
What is lambert eaton? How is it differentiated from myasthenia gravis
Paraneoplastic from small cell
-> proximal myopathy
Weakness improves with repetitive movements
What is Hypertrophic pulmonary osteoarthropathy
Paraneoplastic from lung adenocarcinoma (and rarely small cell)
Osteitis, Gross finger clubbing, and arthritis
Long bones usually affected
What is pancoast found? Where does it affect? Sx?
On CXR
Non small cell [in superior sulcus]
Affects C8 nerve root -> pain down arm
-may get hand muscle wasting
- Horners syndrome
CXR - shadow at apex + possible destruction of 1st/2nd ribs
Most common causes of fever (when neutropenic)
60% Gram positive - staph epi / strep viridans
30% gram neg - E coli, klebsiella, pseudomonas
Roll of MENSA in chemo
To prevent haemorrhagic cystis
[given with some chemo drugs (cyclophosphamide/ifosfamide) to protect bladder]
A and C fibres in pain
A - Acute
C - slower - chronic pain
Colorectal and endometrial cancer as a pair often in?
HNPCC
B symptoms hodgkins
Fevers
Night sweats
Weight loss
Main side effects of hyoscine
Anticolinergic
-> Tachycardia, dry mouth, urinary retention
When might you think colorectal ca is more likely HNPCC than sporadic
Young <45
Second cancer eg endometrial
Usually proximal colon
Strong family Hx
NHS bowel screening in who
60-74 every 2 years
Diagnosis of SIADH
Concentrated urine Na >20
HypoNatraemia <125
High osmolality
NO hypovolaemia, diuretics or oedema/ascities
What is demeclocycline used for
SIADH
->Blocks ADH and causes partial nephrogenic diabetes insipidus
Paraneoplastic cerebella degeneration is in tumours of breast, ovarian, fallopian tube… What is the antibody found
Anti-yo
Anti Hu found in
Small cell lung ca
Anti-ro
SLE
Anti-Tr
Hodgkins lymphoma
[The reed cells]
Anti zic4
small cell lung ca
Gabapentin mechanism
Blocks a2d receptor
Pt lacks capacity and has no NOK. Who is best to contact re DNACPR decision
Independent mental health advocate
Pt treated with doxorubicin (chemo) then develops cardiac failure several months later what has happened
Chemo induced cardiomyopathy
->biventricular failure
Genetic risk factor for breast Ca (not BRCA ?
Other risks
BRCA 1 and 2, TP53
COCP, HRT
Early menarche, late menopause, nulliparity
In order, what are the 2 most common met sites from breast Ca
Bones
Lungs
What should be given after resection of breast Ca
Tamoxifen
When would you get a mastectomy in breast Ca
> 4cm
multifocal
central
ER and HER2 status in Breast Ca prognosis?
ER +ve = better prognosis
HER2 = Poorer prognosis
Tachycardia, flushing, bronchoconstriction, diarrhoea, CV instability = ?
ix?
Carcinoid syndrome
5-HAI
Cancer with bone mets + anaemia. What would be seen on blood film
Leukoerythroblastic blood film
(nucleated erythrocytes and immature white cells of the neutrophilic myeloid series.)
Prostate Ca are adenocarciomas which area of prostate do they usually arise? BPH?
Peipheral zone
BPH is in transition zone
[Transition into old age]
What is the roll of LH agonists in prostate Ca ? Side effects? Eg?
Act on pit -> reduce LH secretion
-> Leydig cells in testes produce less testosterone
Loss of libido, flushing, malaise
Goserelin, buserelin, gonadorelin, leuprolide, nafarelin.
[-relin]
what is cyproterone acetate / flutamide / biclatumide
Anti androgen used in Protstate Ca
Main risks causing thyroid Ca
Radiation
MEN2
BRAF gene
What is most common type of thyroid cancer? Which gene is this linked to - not part of multi-ca syndromes?
Papilliary
BRAF