Onco Flashcards
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
Peutz Jeghers
features of Peutz Jeghers?
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
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
Familial Adenomatous Polyposis
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
HNPCC
what genes are assoc w Breast Ca?
BRCA1 (also Ovarian Ca) and BRCA2 (male breast Ca)
mx of hyperCa secondary to malignancy?
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
Ix of HyperCa in malignancy?
high Ca
low PTH (key to exclude 1o HyperPTH)
CXR
Isotope bone scan
Mx of raised ICP in malignancy?
Dexamethasone
Radio/Chemotx
Ix to investigate raised ICP in malignancy?
CT/MRI
Tumour Lysis Syndrome features?
massive cell destruction ->
high K, urate, phosphate
low Ca
-> renal failure
How to prevent tumour lysis syndrome?
↑ fluid intake + allopurinol 24h before chemo
Rasburicase is an option
Causes of SVC obstruction?
Usually lung Ca
Thymus malignancy
LNs
SVC thrombosis: central lines, nephrotic syndrome
Fibrotic bands: lung fibrosis after chemo
Features of SVC Obstruction?
Headache
Dyspnoea and orthopneoa
Plethora + thread veins in SVC distribution
Swollen face and arms
Engorged neck veins
What sign is specific for SVC obstruction?
Pembertons sign:
Lifting arms above head for >1min → facial plethora, ↑JVP and inspiratory stridor
Due to narrowing of the thoracic inlet
Ix of SVC obstruction?
Sputum cytology
CXR
CT
Venography
Mx of SVC obstruction in malignancy?
Dexamethasone
Consider balloon venoplasty + SVC stenting
Radical or palliative chemo / radio
Prophylaxis of neutropenic sepsis?
co-trimoxazole
Ix of spinal cord compression in malignancy?
urgent MRI spine
presentation of spinal cord compression?
Back pain, radicular pain
Motor, reflex and sensory level
Bladder and bowel dysfunction
Mx of spinal cord compression due to mets?
Dexamethasone
Discuss w neurosurgeon and oncologist
Consider radiotherapy or surgery
AFP tumour marker?
HCC
teratoma
non-malignant causes: hepatitis, cirrhosis, pregnancy
CA 125 tumour marker?
Ovary
Uterus
Breast
non-malignant: cirrhosis, pregnancy
CA 15-3 tumour marker?
Breast
non-malignant:
benign breast disease
CA 19-9 tumour marker?
Pancreas
cholangiocarcinoma
CRC
non-malignant:
cholestasis
pancreatitis
CA 27-29 tumour marker?
breast
neuron-specific enolase tumour marker?
SCLC
CEA tumour marker?
colorectal cancer
non-malignant: pancreatitis, cirrhosis
BHCG tumour marker?
germ cell tumour
non-malignant: pregnancy
PSA tumour marker?
prostate
non-malignant: BPH
Monoclonal Ig tumour marker?
Multiple Myeloma
S-100 tumour marker?
Melanoma
Non-malignant: sarcoma
PLAP tumour marker?
Seminoma
Acid phosphatases tumour marker?
Prostate Ca
Thyroglobulin Tumour marker?
Thyroid Ca
Reasons for chemotherapy?
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
Trastuzumab?
anti-Her2
for HER2+ve breast ca
Bevacizumab?
anti-VEGF
for RCC, CRC, lung
Cetuximab?
Anti-EGFR
Colorectal Ca
Erlotinib?
Tyrosine Kinase inhibitor
lung ca
Imatinib?
tyrosine kinase inhibitor
CML
Ibrutinib?
tyrosine kinase inhibitor
CLL
Common side effects of chemotx?
N+V: prophylactic antiemetic + dexamethasone
Alopecia
Neutropenia
Extravasation of chemo agent: pain, burning, bruising @ infusion site.
Stop infusion, give steroids, apply cold pack
SE cytotoxic abx bleomycin?
pulmonary fibrosis
SE of cyclophosphamide (alkylating agent -chemotx)?
haemorrhagic cystitis
hair loss
BM suppression
which chemotx agent has a SE of haemorrhagic cystitis?
Cyclophosphamide
SE of doxorubicin (cytotoxic Abx)?
Cardiomyopathy
SE of 5-FU?
Mucositis
which chemotx agents cause SE of peripheral neuropathy?
Vincristine
Carboplatin (+ nephrotoxic + n/v)
Reasons for surgery in malignancy?
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
Mechanism of Radiotx?
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
Reasons for radio tx in malignancy?
Radical Rx
Curative intent
40-70Gy
15-30 daily fractions
Palliation
Symptom relief
Bone pain, haemoptysis, cough, dyspnoea, bleeding.
8-30Gy
1-10 fractions
Early reactions to radiotx?
Tiredness
Skin reactions: erythema → ulceration
Mucositis
n/v: occur w stomach, liver or brain Rx
Diarrhoea: pelvic or abdo Rx
Cystitis
BM suppression
Late reactions to radiotx?
Brachial plexopathy: Follows axillary radiotherapy ->Numb, weak, painful arm
Lymphoedema
Pneumonitis: Dry cough ± dyspnoea-> Rx: prednisolone
Xerostomia
Benign strictures
Fistulae
↓ fertility
Panhypopituitarism
Conversion of dose from oral codeine to oral morphine?
Divide by 10
conversion of dose from oral tramadol to oral morphine?
divide by 10
conversion of dose from oral morphine to oral oxycodone?
Divide by 1.5 (used to be 2)
Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation
conversion of dose from oral morphine to subcut morphine?
Divide by 2
conversion of dose from oral morphine to subcut diamorphine?
Divide by 3
conversion of dose from oral oxycodone to subcut diamorphine?
Divide by 1.5
what transdermal patch equates to approximately 30 mg oral morphine daily?
transdermal fentanyl 12 microgram patch
