oncol

Question 1

GISTs

Answer 1

cKIT (CD117) in 85-95% of GIST

About 3-5% of the remainder of KIT -negative GISTs contain PDGFR alpha mutations.

Question 2

melanoma

Answer 2

BRAF 40-60%

RAF mutations were associated with a features of high-risk melanoma, including truncal primary, earlier age ofonset, lack of chronic skin damage, and shortened survival, suggesting the value of inhibiting mutated BRAF.

The BRAF inhibitors vemurafenib and dabrafenib have shown efficacy as monotherapies in patients with previously untreated metastatic melanoma with BRAF V600E or V600K mutations.

Question 3

vesicant cytotoxic drugs (commonly used)

Vesicant extravasation can be defined as the leakage of certain drugs called vesicants out of a vein into the tissue around it.

Vesicants cause blistering and other tissue injury that may be severe and can lead to tissue necrosis (tissue death).

Answer 3

Cisplatin (if > 0.4 mg/mL)
Daunorubicin
Docetaxel
Doxorubicin
Epirubicin
Idarubicin
Mechlorethamine
Mitomycin C
Mitoxantrone
Oxaliplatin
Paclitaxel
Vinblastine
Vincristine
Vinorelbine

Question 4

Crizotinib

Answer 4

untreated advanced ALK-positive NSCLC

Question 5

ABSOLUTE contraindications to breast conservation surgery

Answer 5

1) Persistently positive resection margins after reasonable reexcision attempts.
2) Two or more primary tumors in separate breast quadrants.
3) Diffuse malignant appearing mammographic microcalcifications.
4) A history of prior radiotherapy to the breast or chest wall.This precludes further radiotherapy.
5) Pregnancy, although possible to perform BCT in 3rd trimester, deferring breast radiotherapy until after delivery.

Question 6

BRCA1 mutation

Answer 6

– High grade
– Hormone receptor NEGATIVE (Triple Negative)
– Pushing borders
– Less DCIS
– Medullary histology

BRCA2 tumors do not seem to have specific phenotypic features. But does pose a higher risk of male breast cancer.

Question 7

Tumour lysis syndrome:

Answer 7

– Defined as a combination of metabolic and electrolyte abnormalities occurring spontaneously or following initiation of cytotoxic treatment in patients with cancer. It is characterised by excessive cell lysis.

– Most commonly associated with highly proliferative, bulky, chemosensitive malignancies, such as lymphomas (Burkitt’s lymphoma) and leukemias (acute lymphoblastic leukemia).

– Laboratory tumour lysis syndrome (TLS) is characterised by a combination of any 2 of hyperuricaemia, hyperphosphataemia, hyperkalaemia, or hypocalcaemia.

– Clinical TLS is defined as laboratory TLS with either an increased serum creatinine, cardiac arrhythmia, seizure activity, or sudden death.

Question 8

Risk factors associated with TLS:

Answer 8

– If tumour consists of rapidly dividing cells,
– If bulk of the disease is high
– If response to treatment is good
– Pre-existing renal impairment and/or dehydration
– High serum lactate dehydrogenase and
– High white blood cell count

Age is not an independent risk factor

The increased likelihood of developing TLS is most likely related to a reduction in glomerular filtration rate.