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Medicine > Onco > Flashcards

Onco Flashcards

1
Q

AD transmission

Multiple GI hamartomatous polyps

Mucocutaneous hyperpigmentation: Lips, Palms

10-20% lifetime risk of CRC

Also ↑ risk of other Ca:

Pancreas, Lung, Breast, Ovaries and uterus, Testes

A

Peutz Jeghers

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2
Q

features of Peutz Jeghers?

A

AD transmission

Multiple GI hamartomatous polyps

Mucocutaneous hyperpigmentation: Lips, Palms

10-20% lifetime risk of CRC

Also ↑ risk of other Ca:

Pancreas, Lung, Breast, Ovaries and uterus, Testes

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3
Q

Mutation in APC gene on Chr 5

(TSG Promotes β-catenin degredation. β-catenin is an oncogene which → cell

proliferation)

Cells then acquire another mutation to become Ca: p53, kRAS

AD transmission

~100% risk of CRC by 50yrs

A

Familial Adenomatous Polyposis

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4
Q

Familial clustering of cancers

Lynch 1: CRC

Lynch 2: CRC + other Ca

(Ovarian, Endometrial, Pancreas, Small Bowel, Renal pelvis)

Mutations in DNA mismatch repair genes

AD transmission (variable penetrance)

Often Right-sided CRC

Present @ young age: <50yrs

A

HNPCC

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5
Q

what genes are assoc w Breast Ca?

A

BRCA1 (also Ovarian Ca) and BRCA2 (male breast Ca)

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6
Q

mx of hyperCa secondary to malignancy?

A

Aggressive hydration
- 0.9% NS (e.g. 1L/4h)

  • Monitor volume status
  • Frusemide when full to make room for more fluid

If 1O HPT excluded, give maintenance therapy w bisphosphonate: zoledronate is good

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7
Q

Ix of HyperCa in malignancy?

A

high Ca

low PTH (key to exclude 1o HyperPTH)

CXR

Isotope bone scan

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8
Q

Mx of raised ICP in malignancy?

A

Dexamethasone

Radio/Chemotx

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9
Q

Ix to investigate raised ICP in malignancy?

A

CT/MRI

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10
Q

Tumour Lysis Syndrome features?

A

massive cell destruction ->

high K, urate, phosphate

low Ca

-> renal failure

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11
Q

How to prevent tumour lysis syndrome?

A

↑ fluid intake + allopurinol 24h before chemo

Rasburicase is an option

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12
Q

Causes of SVC obstruction?

A

Usually lung Ca

Thymus malignancy

LNs

SVC thrombosis: central lines, nephrotic syndrome

Fibrotic bands: lung fibrosis after chemo

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13
Q

Features of SVC Obstruction?

A

Headache

Dyspnoea and orthopneoa

Plethora + thread veins in SVC distribution

Swollen face and arms

Engorged neck veins

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14
Q

What sign is specific for SVC obstruction?

A

Pembertons sign:

Lifting arms above head for >1min → facial plethora, ↑JVP and inspiratory stridor

Due to narrowing of the thoracic inlet

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15
Q

Ix of SVC obstruction?

A

Sputum cytology

CXR

CT

Venography

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16
Q

Mx of SVC obstruction in malignancy?

A

Dexamethasone

Consider balloon venoplasty + SVC stenting

Radical or palliative chemo / radio

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17
Q

Prophylaxis of neutropenic sepsis?

A

co-trimoxazole

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18
Q

Ix of spinal cord compression in malignancy?

A

urgent MRI spine

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19
Q

presentation of spinal cord compression?

A

Back pain, radicular pain

Motor, reflex and sensory level

Bladder and bowel dysfunction

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20
Q

Mx of spinal cord compression due to mets?

A

Dexamethasone

Discuss w neurosurgeon and oncologist

Consider radiotherapy or surgery

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21
Q

AFP tumour marker?

A

HCC

teratoma

non-malignant causes: hepatitis, cirrhosis, pregnancy

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22
Q

CA 125 tumour marker?

A

Ovary

Uterus

Breast

non-malignant: cirrhosis, pregnancy

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23
Q

CA 15-3 tumour marker?

A

Breast

non-malignant:

benign breast disease

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24
Q

CA 19-9 tumour marker?

A

Pancreas

cholangiocarcinoma

CRC

non-malignant:

cholestasis

pancreatitis

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25
Q

CA 27-29 tumour marker?

A

breast

26
Q

neuron-specific enolase tumour marker?

A

SCLC

27
Q

CEA tumour marker?

A

colorectal cancer

non-malignant: pancreatitis, cirrhosis

28
Q

BHCG tumour marker?

A

germ cell tumour

non-malignant: pregnancy

29
Q

PSA tumour marker?

A

prostate

non-malignant: BPH

30
Q

Monoclonal Ig tumour marker?

A

Multiple Myeloma

31
Q

S-100 tumour marker?

A

Melanoma

Non-malignant: sarcoma

32
Q

PLAP tumour marker?

A

Seminoma

33
Q

Acid phosphatases tumour marker?

A

Prostate Ca

34
Q

Thyroglobulin Tumour marker?

A

Thyroid Ca

35
Q

Reasons for chemotherapy?

A

Neoadjuvant
Shrink tumour to ↓ need for major surgery

Control early micrometastases

Primary Therapy
E.g. sole Rx in haematological Ca

Adjuvant
↓ chance of relapse: e.g. breast and GI Ca

Palliative
Provide relief from symptoms

Prolong survival

36
Q

Trastuzumab?

A

anti-Her2

for HER2+ve breast ca

37
Q

Bevacizumab?

A

anti-VEGF

for RCC, CRC, lung

38
Q

Cetuximab?

A

Anti-EGFR

Colorectal Ca

39
Q

Erlotinib?

A

Tyrosine Kinase inhibitor

lung ca

40
Q

Imatinib?

A

tyrosine kinase inhibitor

CML

41
Q

Ibrutinib?

A

tyrosine kinase inhibitor

CLL

42
Q

Common side effects of chemotx?

A

N+V: prophylactic antiemetic + dexamethasone

Alopecia

Neutropenia

Extravasation of chemo agent: pain, burning, bruising @ infusion site.

Stop infusion, give steroids, apply cold pack

43
Q

SE cytotoxic abx bleomycin?

A

pulmonary fibrosis

44
Q

SE of cyclophosphamide (alkylating agent -chemotx)?

A

haemorrhagic cystitis

hair loss

BM suppression

45
Q

which chemotx agent has a SE of haemorrhagic cystitis?

A

Cyclophosphamide

46
Q

SE of doxorubicin (cytotoxic Abx)?

A

Cardiomyopathy

47
Q

SE of 5-FU?

A

Mucositis

48
Q

which chemotx agents cause SE of peripheral neuropathy?

A

Vincristine

Carboplatin (+ nephrotoxic + n/v)

49
Q

Reasons for surgery in malignancy?

A

Diagnostics: tissue biopsy or complete removal

Excision: GI, soft-tissue sarcomas, gynae

Often with neo-/adjunctive chemo or radiotherapy

Palliation: e.g. bypass procedures, stenting

50
Q

Mechanism of Radiotx?

A

Ionising radiation → free radicals which damage DNA

Normal cells better at repairing damage than Ca cells

Radiation dose: gray (Gy)
Given in daily fractions

India ink tattoo for reproducible targeting

51
Q

Reasons for radio tx in malignancy?

A

Radical Rx

Curative intent

40-70Gy

15-30 daily fractions

Palliation

Symptom relief
Bone pain, haemoptysis, cough, dyspnoea, bleeding.

8-30Gy

1-10 fractions

52
Q

Early reactions to radiotx?

A

Tiredness

Skin reactions: erythema → ulceration

Mucositis

n/v: occur w stomach, liver or brain Rx

Diarrhoea: pelvic or abdo Rx

Cystitis

BM suppression

53
Q

Late reactions to radiotx?

A

Brachial plexopathy: Follows axillary radiotherapy ->Numb, weak, painful arm

Lymphoedema

Pneumonitis: Dry cough ± dyspnoea-> Rx: prednisolone

Xerostomia

Benign strictures

Fistulae

↓ fertility

Panhypopituitarism

54
Q

Conversion of dose from oral codeine to oral morphine?

A

Divide by 10

55
Q

conversion of dose from oral tramadol to oral morphine?

A

divide by 10

56
Q

conversion of dose from oral morphine to oral oxycodone?

A

Divide by 1.5 (used to be 2)

Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation

57
Q

conversion of dose from oral morphine to subcut morphine?

A

Divide by 2

58
Q

conversion of dose from oral morphine to subcut diamorphine?

A

Divide by 3

59
Q

conversion of dose from oral oxycodone to subcut diamorphine?

A

Divide by 1.5

60
Q

what transdermal patch equates to approximately 30 mg oral morphine daily?

A

transdermal fentanyl 12 microgram patch

Medicine (16 decks)

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