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STEPH BPT 2021 > Oncology > Flashcards

Oncology Flashcards

1
Q

When to cease a cancer drug due to SE

A

If SE impacting function

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2
Q

Spindle cells

A

GIST

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3
Q

CTLA-4 inhibitor

A

Ipilimumab

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4
Q

PD-1 inhibitor

A

Pembrolizumab

Nivolumab

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5
Q

Serum marker elevated in testicular Ca

A

b-HCG

AFP in non-seminoma

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6
Q

Cancers associated with BRAF mutation

A

Melanoma

CRC less commonly

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7
Q

Risk of breast cancer with BRCA

A

70%

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8
Q

BRCA screening

A

MRI / ultrasound yearly from 30

Mammogram after 50

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9
Q

Breast ca screening

A

2 yearly 50 -74

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10
Q

Patients that qualify for axilalry dissection - Early breast cancer

A

> 2 LN

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11
Q

High risk breast Ca

A

HER positive

ER negative

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12
Q

Tamoxifen

A

Eosteogen receptor blocker
Increased DVT/PE
Uterine Cancer
SSRI reduces active tamoxifen (fluoxetine or parole tube)

Treat for 5 years unless high risk

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13
Q

Aromatase inhibitor SE

A

Block conversion if androgen to oestrogen

Post menopausal women

Menopause
Arthralgia
Accelerated osteoporosis

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14
Q

Raised AFP

A

Non seminona

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15
Q

Chemo for testicular cancer

A

Bleomycin
Etoposide
Cisplatin

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16
Q

TTF1 cancer association

A

Adenocarcinoma

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17
Q

MEN-1 cancer association

A

parathyroid gland, anterior pituitary, and enteropancreatic

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18
Q

C-RET cancer assocaition

A

medullary thyroid cancer

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19
Q

FAP screening

A

Annual sigmoidoscopy from age 12 years

Two yearly gastroscopy from 25 years as gastric and duodenal polyposis

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20
Q

Risk factors for Trastuzumab cardiac toxicity

A

Previous or concurrent anthracycline use and age greater than 50 years are the strongest risk factors

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21
Q

Location of CTLA-4

A

T Cell - interacting with APC

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22
Q

Location of PDL-1

A

Tumour cell

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23
Q

Drugs that respond well to immunotherapy

A

Microsatellite-repair (MSI) high tumours
High mutation burden
Melanoma, NSCLC, Bladder, Lung small cell, oesophageal

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24
Q

Prognostic marker for immunotherapy for melanoma

A

High Baseline LDH has poor prognosis

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25
Q

CDK4/6 inhibitor indicates

A

Metastatic
HER 2 negative
Hormone receptor positive

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26
Q

Cheyne stokes breathing

A

Heart failure

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27
Q

Treatment of limited stage 1 Small cell lung cancer

A
  1. Resetion and LN sampling

2. Adjuvent chemo with 4 cycles cisplatin based therapy

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28
Q

Treatment of extensive disease small cell lung cancer

A
  1. 4 cycles platinum based chemotherapy

2. Radiotherapy if good response to chemotherapy

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29
Q

Rx stage I or II NSCLC

A
  1. Resection (lobectomy and LN resection) or steroatactic ablative body radiation with curative intent (if not suitable for surgery)
  2. Adjuvent cisplatin chemotherapy
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30
Q

Rx Stage III NSCLC

A
  1. Surgical resection
  2. Chemo
  3. RT
  4. Immunotherapy with darvalumab if no progression
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31
Q

Rx Stage IV NSCLC
Driver mutation absent
Low PD-L1 expression

A
  1. Chemotherapy (platinum-based doublet)

2. Supplemental Immunotherapy (Pembrolizumab/bevacizumab)

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32
Q

Rx Stage IV NSCLC
Driver mutation absent
High PD-L1 expression (>50%)

A

Immunotherapy first line with pembrolizumab

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33
Q

Rx Stage IV NSCLC

Driver mutation: EGFR

A

Osimertinib

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34
Q

Osimertinib

MOA/SE

A

MOA: EGFR- TKI that selectively inhibits EGFR-TKR-sensitising and EGFR T790M resistant mutations

SE: Aceneiform rash (correlated with treatment response) - steroids

Diarrhoea, ocular, pulomnary, alopecia

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35
Q

Rx Stage IV NSCLC

Driver mutation: ALK gene rearrangement (EML4-ALK fusion oncogene)

A

1st: Alectinib
other: crizotinib

36
Q

Rx Stage IV NSCLC

Driver mutation: ROS-1 rearrangement

A

Crizotinib

MOA: Targets ROS-1 in addition to ALK and MET kinase

37
Q

Rx HCC single lesion and normal portal pressure/bili

38
Q

Rx HCC up to 3 lesions

A

Associated comorbidities: Radiofrequency ablation

Nil comorbidities: Transplant

39
Q

RX HCC Multinodular

A
  1. TACE

2. Sorafenib - Oral multi-kinase inhibitor

40
Q

SE Sorafenib

A

fatigue, fever, diarrhoea, palmar-plantar erythrodysesthesia (hand-foot syndrome)

41
Q

Rx HCC Terminal (Childs Pugh C)

A

Symptomatic

42
Q

Rx SCC/Adnocarcinoma of oesophagus in T4a or less invasive

43
Q

Rx SCC of oesophagus in T4b or metastic

A

Flourouracil plus cisplatin concurrently with RT

44
Q

Rx of Adenocarcinoma of oesophagus

T4b or metastatic

A

carboplatin plus paclitaxel concurrently with RT with follow-up resection

45
Q

Treatment of GIST

A

Resection +/- imitinib

46
Q

Imitinib

A

tyrosine kinase receptor inhibitor

  1. SCF/c-kit receptor tyrosine kinase is activated in gastrointestinal stromal tumor (GIST).
  2. BCR/ABLfusion p TK in CML
47
Q

Targeted agent for metastatic CRC if RAS/RAF wild type

A

EGFR inhibitors
Cetuximab
Panitumimab

48
Q

Targeted agent for metastatic CRC if RAS/RAF mutations

A

VEGF inhibitors:

Bevacizumab

49
Q

Rx of stage 1-2 CRC

50
Q

Rx of Stage 3 CRC (i.e LN positive)

A

Resection

Adjuvent FOLFOX or CAPOX (3 to 6 months)

51
Q

Rx Metastatic CRC (4b)

A
  1. Palliative chemo - FOLFOX/CAPOX/FOLFIRI

2. Targeted agent (VEGF inhibitor/EGFR inhibitor)

52
Q

CRC screening for category 2 risk

A

FOBT 2 yearly from 40 - 49

Colonoscopy 5 yearly 50 -74

53
Q

CRC for category 3 risk

A

FOBT 2 yearly from 35- 39

Colonoscopy 5 yearly from 40 - 74

54
Q

Colonoscopy Screening for FAP

A

1 yearly 10 years
2 yearly 24 + yearly gastroscopy+ thyroid USS _ duodenoscopy
3 yearly 34
5 yearly 44

55
Q

Cancer screening in lynch

A
  1. Yearly colonoscopy from 20/2 years since first diagnosis in family)
  2. 3 yearly gastroscopy from 30

Nil other evidence based

Consider endometrial sampling yearly from 30

56
Q

Treatment of advanced RCC

A
  • Tyrosine kinase inhibitors: anti-VEGF, anti-AXL anti-cMET
  • Anti-PD1 therapy, eg/ nivolumab, ipilimumab
  • mTOR inhibitors
57
Q

Rx Stage III Melanoma (i.e. LN involvement)

A

Surgical dissection

Consider RT + Systemic treatment

58
Q

Rx Metastatic melanoma with BRAF mutations

A

BRAF + MEK inhibitors
o Vemurafenib + cobimetinib
o Dabrafenib + trametinib

59
Q

Rx Metastatic melanoma without BRAF mutations

60
Q

Type of Thyroid cancer that radioactive iodine does not work against

A

Medullary (parafollicular cells)

61
Q

BRCA 1/2 related cancers

A

Breast
Ovary
Prostate
Pancreas

62
Q

Alkylating agents

A

Cyclophosphamide
Isosfamide
Temosolamide
Melphalen

63
Q

SE cyclophosphamide

A 
Haemorrhagic cystitis
Bladder cancer
Infertility
SIADH-like
Lymphopaenia
Cardiotoxicity if given as large dose (BMT)
Fibrosis 
Pneumonitis
64
Q

Anthracyclines (Topoisomerase II inhibitors)

A

Doxorubacin
Epirubacin
Mitoxantrone

65
Q

Anthracycline SEs

A 
Cardiotoxicity - irreversible and dose dependent, effect can be delayed for decades
Palmar plantar erythema
Blistering 
Vasicant rash
Extravasation - Rx: Dexrazoxane
66
Q

Azathioprine SE

A

Rash
Hepatitis
Pancreatitis

67
Q

Bleomycin SE

A

Pneumonitis

Renal and skin

68
Q

Calcineurin inhibitors

A

Tacrolimus

Cyclosporin

69
Q

Calcineurin Inhibitors SE

A 
Nephrotoxicity
Neurotoxicity
Diabetes Tac>cyclo
Electrolytes - K up Mg down 
Acne
Dyslipidaemia 
Malignancy 
Hair loss (tacro) 
Hirsuitism (cyclo)
Drug interaction
70
Q

Mycophenolate SE

71
Q

Platinum-based chemo(crosslink DNA) examples

A

Carboplatin
Cisplatin
Oxaliplatin

72
Q

Platinum-based chemo SE

A

Carbo: Myelosuppressive
Cisplatin: Emetogentic/nephrotoxic, ototoxic
Oxaliplatin: Neurotoxic (PN)
Vesicant rash

73
Q

Pyramidine inhibitors examples

A

Azacitadine in AML
Capecitabine/5FU in CRC
Cytarabine
Gemcitabine

74
Q

Pyramidine SEs

A

Azacitadine: myelosupression
5FU: mucositic, diarrhoea, coronary spasm
Cytarabine: Cerebellar toxicity, encephalopathy, keratitis, mucositis
Gemcitabine: Hepatotoxic, flu-like

75
Q

Taxanes examples (inhibit tubulin)

A

Paclitaxel

Doxetaxel

76
Q

Taxane SEs

A

Peripheral neuropathy
Vesicant toxic
infertility

77
Q

Topoisomerase inhibitors (S Phase) examples

A

Irinotecan

Etoposide

78
Q

Vinca alkaloids (inhibit microtubules in M phase)

A

Vincristine in R-CHOP NHL

Vinblastine in ABVD - HL

79
Q

SEs Vinca alkaloids

A

Headache
Blistering
Neuropathy

80
Q

MOA, indication and SE of Lapatinib

A

MOA: Selective inhibitor of the intracellular tyrosine kinase domains of both ErbB1 (EGFR) and HER2 receptors.

Indication: Metastatic HER+ breast Ca if have progressed on trastuzumab

Brain mets (crosses BBB > trastuz)

SE: Skin reactions

81
Q

Absolute contraindications to breast conserving surgery

A

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.

82
Q

FU stage 1 testicular Ca

A 
1st year monthly.
2nd year 2 monthly
3rd year 3 monthly
4th year 6 monthly
Then yearly.
83
Q

Testicular cancer not responsive to radiotherapy

A

Non seminoma

84
Q

ECOG

A 
0 = fully active
1 = limited activity but ambulatory.
2 = In bed <50% of waking hours.
3 = In bed >50% of waking hours.
4 = completely disabled.
5 = dead
85
Q

most common metastatic melanoma

A

superficial spreading

STEPH BPT 2021 (17 decks)

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