Onco Flashcards
(217 cards)
1
Q
What is the most common cause of malignancy?
A
Genetic mutation of oncogenes or tumour suppressor genes
2
Q
What role do tumour suppressor genes play?
A
Involved in DNA repair mechanisms or checkpoints in the cell cycle
3
Q
Name two commonly discussed tumour suppressor genes.
A
- p53
- BRCA
4
Q
How can genetic mutations occur?
A
They can be inherited or acquired
5
Q
What is the most common mechanism of tumour suppressor gene mutation?
A
Gene deletion from chromosomal translocation or inversion
6
Q
What is the result of oncogene mutation?
A
A ‘gain of function’ for genes involved in cell proliferation or growth
7
Q
Name two commonly discussed oncogenes.
A
- KRAS
- BRAF
8
Q
What are the three major mechanisms for oncogene activation?
A
- Gene mutation
- Gene amplification
- Gene translocation to an area of increased expression
9
Q
What are tumour markers?
A
Biomarkers found in the bloodstream that may indicate specific malignancies
10
Q
What tumour markers and imaging modalities are tested for HCC?
A
AFP in combination with a liver ultrasound for HCC screening in cirrhotics
11
Q
What role do tumour markers play in cancer diagnosis?
A
They play little role in the diagnosis of most cancers and should not be routinely tested
12
Q
What is the strongest evidence for monitoring tumour markers?
A
AFP monitoring during remission from non-seminoma testicular cancer and CEA monitoring during remission from bowel cancer
13
Q
How is prognosis in cancer typically determined?
A
Proportional to staging and functional status at diagnosis
14
Q
What tool is best validated to assess functional status?
A
ECOG Performance Status
15
Q
What does ECOG stand for?
A
Eastern Cooperative Oncology Group
16
Q
What does a fully active ECOG Performance Status indicate?
A
No restriction
17
Q
What are the common groups of chemotherapy agents?
A
- Alkylating Agents
- Antimetabolites
- Antimicrotubule Agents
- Topoisomerase Inhibitors
- Anthracyclines
18
Q
What is the mechanism of action of alkylating agents?
A
Alkylation forms inter-strand cross linking of DNA, forcing the cell to undergo apoptosis
19
Q
Name two common alkylating agents.
A
- Cyclophosphamide
- Cisplatin
20
Q
What are common side effects of chemotherapy?
A
- Peripheral neuropathy
- Nephrotoxicity
- Nausea and vomiting
- Ototoxicity
- Electrolyte disturbance
- Haemolytic anaemia
21
Q
What is a common side effect of Vinca Alkaloids?
A
Peripheral neuropathy
22
Q
What is the mechanism of action for antimetabolites?
A
Inhibition of RNA and DNA synthesis
23
Q
Name two common antimetabolites.
A
- Methotrexate
- Fluorouracil (5-FU)
24
Q
What is a common side effect of topoisomerase inhibitors?
A
Alopecia
25
What is febrile neutropenia?
Fever in the setting of neutropenia, considered a medical emergency
26
Which infections are commonly reactivated due to immunosuppression from chemotherapy?
* Tuberculosis
* Hepatitis B
27
What is a common adverse effect of chemotherapy related to hair?
Alopecia
28
What is the primary treatment for hypercalcemia in malignancy?
Aggressive intravenous fluid resuscitation
29
What is tumour lysis syndrome?
A condition that can occur after chemotherapy due to the breakdown of large numbers of tumour cells
30
What are common electrolyte changes in tumour lysis syndrome?
* Hyperuricaemia
* Hyperkalaemia
* Hyperphosphataemia
* Hypocalcaemia
31
What is the main purpose of prophylactic allopurinol in chemotherapy?
To prevent tumour lysis syndrome
32
What are common skin reactions associated with chemotherapy?
* Hand-foot syndrome
* Acne-type reactions
33
What is the role of prophylactic storage of sperm and oocytes in chemotherapy?
To address potential infertility following treatment
34
What class of agents is commonly associated with cardiotoxicity?
Anthracyclines
35
What is the mechanism of action of taxanes?
Block cell division by preventing microtubule function
36
What is thrombosis?
Formation of a blood clot inside a blood vessel.
37
What does EPO stand for?
Erythropoietin.
38
What is thymoma?
A tumor originating from the thymus gland.
39
What condition is characterized by eye muscle weakness that is inducible?
Myasthenia Gravis.
40
True or False: Hypercalcaemia in malignancy is generally PTH-dependent.
False.
41
What are the two primary causes of hypercalcaemia in malignancy?
* Skeletal metastases
* Ectopic PTH-related peptide secretion.
42
What is the first line treatment for hypercalcaemia in malignancy?
Aggressive intravenous fluid resuscitation.
43
If calcium levels remain raised after initial treatment, what therapy is indicated?
Bisphosphonate therapy.
44
What is the third line treatment for hypercalcaemia in malignancy?
Calcitonin.
45
What is extravasation injury?
Leakage of chemotherapy contents from intravenous lines causing significant local tissue injury.
46
Which type of venous access reduces the risk of extravasation injury?
Central venous catheter.
47
True or False: All chemotherapy agents can cause extravasation injury.
True.
48
What are the management steps for extravasation injury?
* Cessation of the infusion
* Ice packs over the injury site
* Antidote therapy
* Plastic surgery referral.
49
What is tumor resistance?
Mechanisms developed by tumor cells to survive chemotherapy drugs.
50
What is the primary method of tumor resistance to chemotherapy?
Use of drug efflux pumps on the cell surface.
51
What are other mechanisms of tumor resistance besides drug efflux pumps?
* Over-replication of target genes
* Defective apoptosis pathways.
52
What are common side effects of platinums?
* Peripheral neuropathy
* Nephrotoxicity
* Ototoxicity
* Nausea
* Hemolytic anemia.
53
What are common side effects of antimetabolites?
* Bone marrow suppression
* Hepatotoxicity
* Mucositis.
54
What is the main side effect of anthracyclines?
Cardiotoxicity.
55
What is the mechanism of action of Antibody Drug Complexes (ADC)?
An antibody molecule targets specific tumor cells with a cytotoxic drug attached.
56
What innovative therapy involves engineering T-cells to recognize tumor cells?
Car-T-Cells.
57
What is the most common solid organ malignancy in young males?
Testicular cancer.
58
What is the typical age range for the onset of testicular cancer?
20-39 years.
59
What is the overall survival rate for testicular cancer?
Approximately 95%.
60
What are the two main types of testicular tumors?
* Seminoma
* Non-seminoma.
61
What is the cure rate for metastatic seminoma?
Approximately 85%.
62
What are independent risk factors for testicular cancer?
* Klinefelter's Syndrome (XXY)
* Uncorrected cryptorchidism.
63
How do most patients present with testicular cancer?
With a testicular mass.
64
What is the primary diagnostic tool for testicular masses?
Ultrasound.
65
What tumor marker is associated with non-seminoma testicular cancers?
Alpha Fetoprotein (AFP).
66
What is the TNM classification used for?
Staging cancers.
67
What is the management for Stage I seminoma?
Orchidectomy.
68
What is the typical management for Stage II seminoma?
Localized radiotherapy or single-agent Carboplatin.
69
What is the median age of diagnosis for prostate cancer?
69 years.
70
What are common risk factors for prostate cancer?
* Age over 50
* African-American and Caucasian ethnicity
* Family history.
71
What is the most common presentation of prostate cancer?
Asymptomatic in early stages.
72
What screening method is controversial for prostate cancer?
Prostate specific antigen (PSA).
73
What is the definitive test to diagnose prostate cancer?
Histological confirmation via biopsy.
74
What is the recommended management for localized prostate cancer?
* Surgery - Radical prostatectomy
* Radiation therapy.
75
What is the first-line treatment for metastatic prostate cancer?
Androgen deprivation therapy (ADT).
76
What is the standard of care for castrate-resistant prostate cancer?
Second line therapies including androgen receptor blockade.
77
What is the most common invasive malignancy in women?
Breast cancer.
78
What is the lifetime risk of breast cancer for women?
12% or 1 in 8.
79
What are strong risk factors for breast cancer?
* Being female
* Age
* Family history.
* BRCA mutations.
80
What is DCIS?
Ductal Carcinoma In Situ, a non-invasive breast cancer.
81
What is recommended for women with BRCA mutations?
* Prophylactic bilateral mastectomy
* Bilateral salpingo-oophorectomy.
82
What should women with a significant family history of breast cancer consider?
Genetic testing for BRCA mutations.
83
What is a breast mass?
A breast mass can involve distortion of breast shape and architecture, nipple inversion, and inflammatory skin changes
## Footnote
It can be a consequence of metastatic disease.
84
What does DCIS stand for?
Ductal Carcinoma In Situ
## Footnote
It is a non-invasive cancerous lesion of the breast.
85
What are the key characteristics of DCIS?
Identified only on screening mammography, does not produce clinical signs or symptoms, microcalcifications with ductal tissue are pathognomic
## Footnote
There is no risk of lymph node involvement or metastatic spread.
86
What is the recommended treatment for DCIS?
Breast conserving lumpectomy and adjuvant radiation therapy in most cases
## Footnote
Adjuvant tamoxifen should be given for at least 5 years if estrogen receptor positive.
87
What is the 5-year survival rate for DCIS?
>95%
## Footnote
This indicates a very favorable prognosis.
88
What is LCIS?
Lobular Carcinoma In Situ
## Footnote
It is a less common condition compared to DCIS.
89
How is LCIS typically detected?
Detected on screening mammography, with no microcalcifications seen
## Footnote
There are no clinical signs or symptoms.
90
What are the treatment options for LCIS?
Observation with repeated imaging, hormonal therapy, or surgical intervention
## Footnote
Treatment guidelines vary in different locations.
91
What defines invasive carcinoma?
A lesion that is no longer carcinoma-in-situ and can be ductal or lobular in origin
## Footnote
Staging of the tumor is important for prognosis and treatment.
92
What are the risk factors for aggressive invasive carcinoma?
* Inflammatory breast and skin changes
* Palpable lymphadenopathy
* Negative receptor status (triple negative disease)
## Footnote
Negative receptor status includes negative ER, PR, and HER.
93
What is the recommended frequency for mammograms in women aged 50-74?
Every second year
## Footnote
There are no recommendations to screen entire populations for genetic mutations such as BRCA.
94
What should be done if a suspicious lesion is identified on mammography?
Further investigation is required
## Footnote
For suspected DCIS, lumpectomy and later tissue diagnosis is recommended.
95
What is the purpose of sentinel lymph node assessment during surgery?
To assess for metastatic spread
## Footnote
This involves injecting dye to find the nearest sentinel lymph node.
96
What does the TNM classification stage 0 represent?
DCIS or LCIS
## Footnote
It indicates non-invasive stages of breast cancer.
97
What is the role of chemotherapy in breast cancer treatment?
Adjuvant chemotherapy should be provided in high risk and advanced stage disease
## Footnote
Neoadjuvant therapy may be considered for very large tumors.
98
What is the Oncotype DX assay used for?
Testing for mutations and evaluating the risk of local recurrence or unidentified metastatic disease
## Footnote
It provides a validated scoring tool using 21 identified genetic markers.
99
What are common side effects of chemotherapy?
* Alopecia
* Pancytopenia
* Mucositis
* Anthracycline-induced cardiomyopathy
## Footnote
These side effects vary depending on the specific treatment regimen.
100
What is the standard of care following lumpectomy in DCIS?
Radiation therapy
## Footnote
It is also indicated for Stage 1 disease.
101
What types of hormonal therapy are indicated for ER+ tumors?
* Selective estrogen receptor modulators (SERM) - Tamoxifen
* Aromatase Inhibitors - Anastrozole, Letrozole, Examestane
## Footnote
Treatment options depend on menopausal status.
102
What is the role of Trastuzumab?
A monoclonal antibody targeting HER2 receptor in HER2+ tumors
## Footnote
It improves survival in Stage 1-3 tumors when combined with standard treatment.
103
What are PARP inhibitors used for?
Repairing single strand DNA breaks
## Footnote
They are beneficial in BRCA positive and triple negative metastatic breast cancer.
104
What is the primary treatment for endometrial cancer?
Hysterectomy plus bilateral salpingo-oophorectomy
## Footnote
It is curative in early-stage disease.
105
What is the most common symptom of endometrial cancer?
Abnormal menstrual bleeding
## Footnote
It occurs in 90% of cases.
106
What is the FIGO staging for endometrial cancer Stage 1?
Limited to the endometrium
## Footnote
Higher stages involve extension beyond the uterus.
107
What is the most common histological subtype of endometrial cancer?
Adenocarcinoma
## Footnote
It is the most frequently diagnosed gynecological malignancy.
108
What is the median age at diagnosis for ovarian cancer?
63 years of age
## Footnote
The risk increases significantly with age.
109
What are common risk factors for ovarian cancer?
* Early menarche
* Late menopause
* Nulliparity
* Obesity
## Footnote
Familial syndromes like HNPCC or BRCA mutations also significantly increase risk.
110
What is the role of prophylactic bilateral salpingo-oophorectomy?
It should be considered for women with BRCA mutation or HNPCC after childbearing years
## Footnote
This is regardless of whether malignancy is present.
111
What is the FIGO staging for ovarian cancer Stage 3?
Retroperitoneal or peritoneal extension
## Footnote
Stage 4 indicates distant metastases.
112
What are the common treatments for relapsed endometrial cancer?
* Surgery
* Chemotherapy
* Radiotherapy
## Footnote
Treatment is case-by-case based on the patient's situation.
113
What is indicated for Stage 4 itoneal extension?
Distant metastases
## Footnote
Management includes surgery and chemotherapy.
114
What surgical procedures may be performed for Stage 4 itoneal extension?
Bilateral salpingo-oophorectomy with total abdominal hysterectomy, omentectomy, retroperitoneal lymph node dissection
## Footnote
Omentectomy may be performed if involved.
115
What is the significance of histology from surgical tissues in cancer staging?
Often upstages patients from Stage 2 to Stage 3 disease.
116
What is the chemotherapy regimen for Stage 1 high-grade tumors to Stage 4?
Adjuvant therapy is required.
117
What are general chemotherapy regimes for advanced cancer?
6 cycles of Taxane plus Cisplatin, intraperitoneal chemotherapy
## Footnote
Side effects include bowel obstruction, neutropenia, and ascites.
118
How often should clinical examinations and Ca-125 tests be performed after treatment?
Every 3 months.
119
What is the prognosis for women with Stage 2 cervical cancer with active treatment?
5-year survival of 70%.
120
What is the most common type of cervical cancer?
Squamous cell carcinoma (90%).
121
What are the major risk factors for cervical cancer?
Infection with HPV types 16 and 18, multiple sexual partners, smoking, multiple pregnancies, long-term use of oral contraceptive pill.
122
What impact does the Gardasil vaccine have on cervical cancer risk?
Reduces the risk by over 90%.
123
What is the first line investigation for cervical cancer?
Pap smear.
124
What does CIN stand for in the context of cervical cancer?
Cervical intraepithelial neoplasia.
125
What is the FIGO staging system for cervical cancer?
Stage 1a - microscopic disease, Stage 1b - macroscopic disease, Stage 2 - outside uterus, Stage 3 - invasion of pelvic wall, Stage 4 - involvement of bladder/rectum or distant metastases.
126
What is the leading cause of cancer-related death in Australia?
Lung cancer.
127
What is the most common subtype of non-small cell lung cancer (NSCLC)?
Adenocarcinoma.
128
What are the presenting complaints of lung cancer?
Dry cough, haemoptysis, weight loss, dyspnoea, pleural effusion symptoms.
129
What are the common complications of non-small cell lung cancer?
Malignant pleural effusions, superior vena cava obstruction, tracheal or bronchial compression, paraneoplastic syndromes.
130
What is the typical prognosis for limited stage small cell lung cancer (SCLC)?
Median 12 months survival with chemotherapy.
131
What are classical risk factors for colorectal cancer?
Older age, male, higher alcohol intake, cigarette smoking, processed and red meat intake, sedentary lifestyle.
132
What symptoms should prompt investigation for colorectal cancer?
Significant change in bowel habit, rectal bleeding, unexplained weight loss.
133
What type of cancer is most commonly associated with inflammatory bowel disease?
Colorectal carcinoma.
134
What are the associations of olyticus with colorectal cancer?
Oltyticus are associated with colorectal cancer and warrant exclusion of bowel malignancy once the infection is treated.
135
What percentage of colorectal cancer diagnoses are made in patients with no genetic risk?
90% of colorectal cancer diagnoses.
136
List the classical risk factors for colorectal cancer.
* Older age
* Male
* Higher intake of alcohol
* Cigarette smoking
* Processed and red meat intake
* Sedentary lifestyle
137
What groups have an increased risk of colorectal cancer?
Patients with Inflammatory Bowel Disease and genetic predisposition.
138
What is the risk of colorectal carcinoma in Inflammatory Bowel Disease (IBD) after 30 years?
The risk approaches 20%.
139
What are the two types of Inflammatory Bowel Disease that increase colorectal cancer risk?
* Crohn's Disease
* Ulcerative Colitis
140
What is the increased risk associated with Ulcerative Colitis?
The risk is greater with chronic inflammation and no histological remission.
141
What is the independent risk factor for colorectal cancer related to family history?
First degree family history alone is an independent risk factor.
142
What is the lifetime risk of colorectal cancer in Hereditary Non Polyposis Colorectal Cancer (HNPCC)?
80% lifetime risk.
143
What are the common cancers associated with HNPCC?
* Right-sided colorectal cancer
* Endometrial cancer
* Stomach cancer
* Ovarian cancer
* Ureteric and bladder cancers
144
What genetic mutations are associated with HNPCC?
* MSH2 (60%)
* MLH1 (30%)
* MSH6
* PMS2
* EPCAM
145
What criteria identify patients to test for HNPCC?
* Three or more family members with colorectal cancer
* Two successive generations
* One person diagnosed younger than 50 years of age
* Exclusion of FAP
146
What is the recommended screening interval for malignancy in HNPCC?
Colonoscopy every 1-2 years from 20 years of age.
147
What surgical procedure is recommended if colorectal cancer is diagnosed in a patient with proven HNPCC?
Total colectomy.
148
What are the three major forms of Familial Adenomatous Polyposis (FAP)?
* FAP - Most common and severe
* Attenuated FAP - Second most common, mild
* Autosomal recessive FAP - rare mutation of MUTYH gene
149
What gene mutation is responsible for classical FAP?
Mutation of the APC gene.
150
At what age do over 90% of patients with classical FAP develop hundreds of polyps?
By age 30.
151
What is the median age of colorectal cancer diagnosis in patients with classical FAP?
39 years of age.
152
What is the lifetime risk of colorectal cancer in Attenuated FAP?
70% lifetime risk.
153
What is the recommended age for annual colonoscopy in patients with FAP?
From the age of 10 years.
154
What are the indications for complete colectomy in FAP patients?
* Diffuse polyps (>100)
* Multiple polyps >1cm
* Severe dysplasia within polyps
* Malignancy
155
What guidelines are used for colorectal cancer screening?
Based on colorectal cancer pathogenesis principles.
156
What is the recommended screening for average risk, asymptomatic patients?
FOBT at 50 years of age.
157
What is the screening recommendation for higher risk populations?
Colonoscopy intervals based on specific guidelines.
158
What is the significance of adenomatous polyps in colorectal cancer?
Adenomatous polyps progress to carcinoma; hyperplastic polyps do not.
159
What is the 5-year survival rate for Stage IV colorectal cancer?
<20%.
160
What is the primary treatment for melanoma?
Surgical excision.
161
What are the early macroscopic changes in melanoma during the radial growth phase?
* Asymmetry
* Border uneven
* Colour difference
* Diameter >6mm
* Elevation or enlargement
162
What is the most common form of melanoma?
Superficial Spreading melanoma.
163
What is the prognosis for Acral Melanoma?
Prognosis is extremely poor.
164
What does the Clark level refer to in melanoma?
Extent of vertical growth.
165
What is the AJCC Staging System used for?
Staging melanoma.
166
What is the independent risk factor for poor prognosis in melanoma?
Presence of ulceration.
167
What is the management for Stage 1 melanoma?
Requires no further investigation or management.
168
What is the recommendation for sentinel lymph node positive disease in melanoma?
Total lymph node dissection of the involved group.
169
What is the current standard of care for Stage 3 disease with sentinel lymph node positive disease?
Observation is currently the standard of care
## Footnote
Total lymph node dissection is indicated but does not improve survival.
170
What is the recommended treatment for Stage 4 disease with single metastatic deposits?
Surgical resection of the single metastatic deposit is recommended
## Footnote
There is little benefit from standard chemotherapy regimens.
171
What are the two BRAF inhibitors mentioned?
* Dabrafenib
* Vemurafenib
## Footnote
Dabrafenib targets all V600 mutations; Vemurafenib targets V600E mutations only.
172
What is the role of BRAF mutations in melanoma?
BRAF mutations are the most common genetic driver mutations in intermittent sun exposure melanomas
## Footnote
They occur in approximately 55% of superficial spreading melanomas.
173
What is the mechanism of action of Ipilimumab?
Ipilimumab binds to the CTLA-4 receptor, preventing B7 from binding CTLA-4
## Footnote
This allows cytotoxic T-cells to continue being activated.
174
What are the side effects of Vemurafenib?
* Skin keratosis
* Increased risk of SCC
* Increased risk of BCC
## Footnote
SCC and BCC refer to squamous cell carcinoma and basal cell carcinoma, respectively.
175
What are the main side effects of immunotherapy agents?
* Autoimmunity
* Thyroiditis
* Adrenalitis
* Pituititis
* Dermatitis
* Colitis
* Pneumonitis
* Hepatitis
## Footnote
Severe Grade 3-4 toxicities commonly occur.
176
What is the prognosis for early-stage pancreatic cancer following surgical intervention?
Curative surgical intervention is possible
## Footnote
For stage 3-4 disease, the 1-year survival is 25% and the 5-year survival approaches 0%.
177
What is the most common type of pancreatic cancer?
Pancreatic adenocarcinoma is the most common tissue type (85%)
## Footnote
It primarily arises from glandular tissue.
178
What are common symptoms of malignant neuroendocrine tumors?
* Diarrhoea
* Flushing
## Footnote
These symptoms occur due to hormone secretion independent of normal homeostasis.
179
What is the primary risk factor for developing pancreatic cancer?
Cigarette smoking is a very strong risk factor
## Footnote
Chronic pancreatitis also significantly increases the risk.
180
What is the role of endoscopic retrograde cholangiopancreatography (ERCP) in pancreatic cancer?
Tissue diagnosis can be made by ERCP
## Footnote
Fine needle aspiration allows histological assessment.
181
What is the TNM classification for Stage 1 pancreatic cancer?
Confined to pancreas, A-tumour <2cm, B-tumour >2cm
## Footnote
Staging is crucial for determining treatment.
182
What are common symptoms of oesophageal cancer?
* Dysphagia
* Odynophagia
* Regurgitation
* Vomiting
* Weight loss
## Footnote
These symptoms arise as the tumor infiltrates large portions of the oesophagus.
183
What is the 5-year survival rate for oesophageal cancer?
15% overall
## Footnote
Early-stage mucosal disease has a 5-year survival rate of 80%.
184
What is the primary type of oesophageal cancer diagnosed in developed countries?
Adenocarcinoma
## Footnote
This is due to the rising incidence of Barrett's oesophagus.
185
What is the first-line chemotherapy for pancreatic cancer?
Gemcitabine plus Paclitaxel is considered first-line chemotherapy
## Footnote
FOLFIRINOX may be considered for good candidates.
186
What is the significance of PD-1 inhibitors in cancer treatment?
They block the inhibitory signal sent by tumour cells
## Footnote
Examples include Nivolumab and Pembrolizumab.
187
What are the characteristics of functioning neuroendocrine tumors?
They secrete hormones such as insulin, gastrin, and glucagon
## Footnote
Symptoms include diarrhoea and flushing.
188
What is a common finding in patients with stage 4 pancreatic cancer?
Patients typically present with metastatic disease
## Footnote
Abdominal pain and systemic symptoms are common.
189
What is the management approach for stage 3 and 4 pancreatic cancer?
Management is often non-curative and debatable regarding chemotherapy
## Footnote
Surgical resection is key for early-stage disease.
190
What is the role of radiation therapy in oesophageal cancer?
It can be provided prior to surgery, adjuvant to surgery, or alone in the palliative setting
## Footnote
Curative intent radiotherapy can be performed in patients contraindicated for surgery.
191
What is the role of screening for oesophageal cancer in the general population?
There are no screening programs in existence
## Footnote
Patients with Barrett's Oesophagus should undergo regular endoscopic screening.
192
What is the significance of the COMB/-7 and CO-BRIM studies?
They showed improved progression-free survival and overall survival with combination therapy
## Footnote
Combination of BRAF and MEK inhibitors is the standard of care.
193
What is the typical presentation of patients with oesophageal cancer?
Patients typically do not present until the tumour has infiltrated large portions of the oesophagus
## Footnote
Common symptoms include dysphagia and odynophagia.
194
What is the treatment for autoimmune complications caused by immunotherapy?
Intravenous methylprednisolone followed by a weaning course of oral corticosteroids
## Footnote
Infliximab may be used as a second-line agent.
195
What type of tumors do GIST represent?
Gastrointestinal stromal tumours
## Footnote
GIST arise in the smooth muscle cells of the GI tract, not from epithelial cells.
196
What gene mutation drives GIST?
cKIT gene mutation
## Footnote
These mutations are crucial for the development of GIST.
197
Where do the majority of GIST tumors occur?
In the stomach
## Footnote
GISTs in the stomach have a lower malignant potential compared to those in other locations.
198
How do GIST tumors typically grow?
Exophytic fashion
## Footnote
They rarely metastasize.
199
What are the most common presenting complaints of GIST?
GI bleeding or dysphagia
## Footnote
Gastric obstruction is uncommon.
200
What is the primary method of diagnosing GIST?
Endoscopy and tissue biopsy
## Footnote
Histology shows excess connective tissue and positive cKIT staining.
201
What treatment can cure small, localized GIST?
Surgical resection
## Footnote
Larger tumors or metastatic disease require different treatment.
202
What medication is used for larger tumors or metastatic GIST?
Imatinib
## Footnote
Imatinib has excellent outcomes for treating GIST.
203
What was Imatinib initially created for?
bcr-abl inhibition in CML
## Footnote
It is effective against cKIT in GIST.
204
What is a strong risk factor for gastric cancer?
Helicobacter pylori
## Footnote
Hypervirulent strains like CagA further increase this risk.
205
Which lifestyle factors increase the risk of gastric cancer?
Smoking and alcohol
## Footnote
There is no proven link between diet and gastric cancer.
206
Which genetic mutation is linked to gastric cancer?
CDH1 gene mutation
## Footnote
Inherited genetic germ line mutations have been proven in gastric cancer.
207
What are common symptoms of gastric cancer presentation?
Abdominal discomfort, heartburn, loss of appetite
## Footnote
Incidental findings can occur during endoscopy.
208
Is there a role for routine screening for gastric cancer?
No
## Footnote
Screening and treatment of H pylori is indicated for patients with upper GI symptoms.
209
What is the initial investigation for gastric cancer?
Upper endoscopy
## Footnote
It allows for tissue diagnosis.
210
What does staging for gastric cancer involve?
CT chest, abdomen, and pelvis
## Footnote
PET is not routinely used.
211
What does TNM stand for in staging?
Tumor, Node, Metastasis
## Footnote
This system is used to stage gastric cancer.
212
What surgical interventions are indicated for early-stage gastric cancer?
Partial or total gastrectomy
## Footnote
Palliative surgical intervention may also relieve symptoms.
213
What is the evidence for chemotherapy in gastric cancer?
No significant mortality benefit
## Footnote
There is no role for neoadjuvant treatment.
214
What are common chemotherapy regimens for gastric cancer?
Fluorouracil, capecitabine, platinums, anthracyclines
## Footnote
These have varying effects.
215
What is the role of radiation therapy in gastric cancer?
Adjunct to surgery or chemotherapy
## Footnote
It is not a standalone treatment.
216
What targeted therapy is used for HER2 positive gastric cancer?
Trastuzumab
## Footnote
It improves survival in inoperable or metastatic cases.
217
What is the overall prognosis for gastric cancer?
Poor
## Footnote
The average 5-year survival is approximately 10%.
