ONCO

Question 1

name the 5 most common site for head and neck cancers

Answer 1

nasophrynx
oral cavithy
oropharynx
hypopharynx
larynx

Question 2

what is the most commonhistological type of head & neck cancer

Answer 2

squamous ce3ll carcinoma

Question 3

what is the main risk factor for Head and neck cancers

give 2 others

Answer 3

HPV (16)

2 others: alcohol, smoking, EBV

Question 4

give 5 Sx suggesting head & neck cancer

Answer 4

• Dysphagia
• odynophagia
• dysphonia ,
• ALARM symptoms ( tiredness, unexplained weight loss, loss of appetite)
• Lymphadenopathy
  o Many cancers may just present as a neck lump due to metastasis to lymph node
• airway compromise (stridor)
• halitosis
• focal neurology (VII cranial nerve palsy)

Question 5

what is the genetic inheritance of Li-Fraumeni syndrome

Answer 5

Autosomal dominant

an inherited condition that is characterized by an increased risk for certain types of cancer (sarcomas/ leukaemiaS)

Question 6

mutations to what gene causes Li-Fraumeni syndrome

Answer 6

p53 tumour suppressor gene

Question 7

what cancers are associated with Li Fraumnei syndrome

Answer 7

an inherited condition that is characterized by an increased risk for certain types of cancer.

Question 8

when are Ix for Li-Fraumeni syndrom conducted

Answer 8

Hx sarcoma in <45 yo

1st degree relative with cancer <45 + other family member with malignancy (<45yo) or sarcoma ( any age)

Question 9

on what chromosome is BRCA 1 carried

Answer 9

17

Question 10

what chromosome is the BRCA 2 gene found

Answer 10

13

Question 11

the BRCA genes are associated with a 60% risk of developing breast cancer. what other cancer are females with these genes at risk of devloping

Answer 11

ovarian
( 55% risk with BRCA 1 , 25% risk with BRCA 2)

Question 12

the BRCA genes are associated with a 60% risk of developing breast cancer. Which of these genes increases the risk of what other cancer in males ?

Answer 12

prostate
BRCA 2

Question 13

what is hereditary non-polyposis colorectal cancer (HNPCC) also known as

Answer 13

lynch syndrome

Question 14

what is the hereditary pattern of lynch syndrom

Answer 14

AD

( as with Li-Fraumeni)

Question 15

what cancers are people with Lynch syndrome at risk of devloping at a young age?

Answer 15

colonic
endometrial

Question 16

what criteria is used to determine the risk of having lynch syndrome

Answer 16

amsterdam criteria

Question 17

what are the features of amsterdam criteria

Answer 17

> /=3 family members with confirmed colorectal cancer ( 1 is 1st degree relative of the other 2)
2 successive affected generations
/= 1 colon cancer in diagnosed <50yrs
Familial adenomatous polyposis has been excluded

Question 18

what gene is mutated in Gardners syndrome

Answer 18

APC gene (chromosome 5)

Question 19

what is the genetic inheritance of gardners syndrome

Answer 19

AD
( like Li-Fraumeni (breast cancer) and Lynch (colon cancer) )

Question 20

what are the non-GI signs of gardners syndrome

Answer 20

skull osteoma, thyroid cancer and epidermoid cysts, dental issues (e.g caries/ supernumary teeth)

Question 21

what Mx is often used in pts with Gardners syndrome

Answer 21

colectomy to reduce colorectal cancer risk

Question 22

what anti-emetic is used in nausea and vomiting caused by intracranial tumours

Answer 22

dexamethasone

(reduces ICP)

Question 23

Sx of metastasis to bones (x2)

Answer 23

pain
pathological fractures
hypercalcaemia
raised ALP ( raised ALP on its own is bone)

Question 24

sx metastasis to brain (x3)

Answer 24

headaches
seizures
neuro deficits

Question 25

Sx metastasis of lung cancer

Answer 25

cough
SOB
chest pain

Question 26

what are the most common causes of bone mets (x3)

Answer 26

descrending order
prostate
breast
lung

Po – Prostate
R – Renal
Ta – Thyroid
B – Breast
Le – Lung

Question 27

what cancers typically metastesis to the lung

Answer 27

breast (also common in bone)
colorectal
renal (also common in bone)
bladder
prostate (also common in bone)

Question 28

how do lung mets appear on X-ray

Answer 28

cannonball metastases

multiple, round, well-defined lung cancers

most common with renal cell cancer but also choriocarcinoma/prostate

Question 29

what is the monoclonal antibody tumour marker for breast cancer?

Answer 29

CA 15-3

Question 30

what is the monoclonal antibody tumour marker for pancreatic cancer?

Answer 30

CA 19-9

Question 31

what is the monoclonal antibody tumour marker for ovarian cancer?

Answer 31

CA 125

( think of them in order form top to bottom - breast (15-3), pancreas (19-9), ovarian (125))

Question 32

what is the tumour antigen tumour marker for prostatic carcinoma?

Answer 32

Prostate specific antigen (PSA)

Question 33

what is the tumour antigen tumour marker for hepatocellular carinomas & teratomas ?

Answer 33

alpha-feto protein (AFP)

Question 34

what is the tumour antigen tumour marker for colorectal cancer?

Answer 34

carcinoembryonic agent (CEA)

Question 35

what is the tumour antigen tumour marker for melanoma & schwannomas ?

Answer 35

S-100

Question 36

what cancer(s) does the tumour antigen bombesin indicate?

Answer 36

small cell lung carcinoma
gastic cancer
neuroblastoma

Question 37

how do pathological fractures appear

Answer 37

compression fractures and focal sclerotic bony lesions.

Question 38

how do the fractures in bone mets differ to those in Pagets disease of the bone/multiple myeloma on X-ray

Answer 38

multiple myeloma/ pagest disease
osteolytic lesions ( loss of bones)

bone mets - sclerotic regions - thick areas of bones

Question 39

apart from metastatic cancer and multiple myeloma, give 2 causes of pathological fractures

Answer 39

cancerous: sarcoma

non-cancerous: metabolic:
- osteoporosis,
- hyperparathyroidism

Bone disease
pagets disease

Question 40

what is the most common cause of pathological fractures

Answer 40

tumours

Question 41

features suggesting a pathological fracture

Answer 41

Pain: localised, severely disproportionate to injury

fracture followign minor trauma

deformity at fracture site

impaired function of affected limb

Question 42

what genetic condition are desmoid tumours associated with

Answer 42

Gardners syndrome, mutation of PAPC gene on chromosome 5

desmoid tumours (fibrous growths which occur anywhere in the body) are found in 15% of cases

Question 44

what is the difference in location between squamous cell lung canrcinomas and lung adenocarcinomas

Answer 44

squamous cell - close to large airways “lung nodule in close proximity to his left main bronchus.”

adenocarcinomas: peripheral lung