Oncology

Question 1

Capecitabine

Answer 1

Cause diarrhea: - Capecitabine ( stop if uncontrolled diarrhea) and - Indapamide (thiazide like diuretics )

• Treats diarrhea –> Loperamide
• Causes constipation –> Codeine

Question 2

Secondary Metastasis to the Brain

Answer 2

In Raised ICP For Nausea- best is Cyclizine

For the glioma/cerebral edema to shrink - Dexamethason 4mg 4 times daily
(shrinks the edema within hrs) and reduce ICP

Question 3

Thyroid globulins levels after thyroidectomy

Answer 3

After thyroidectomy, Tg levels should be undetectable, but if they are not, then its a big concern

Question 4

Testicular Tumours

Answer 4

seminoma-- clear cells embryonal 
CA-- immature primitive cells 
choriocarcinoma-- placenta like tissue 
lymphoma-- diffuse B-cells 
teratoma-- cartilage, hair, skin

seminomas(most common)=Large cells with a central nucleaus

teratoma(malignant is males, benign in females) = 2 layers are present 1=mesoderm(cartilage) 2=ectoderm=(sq. epithelium and hair)

testicular lymphoma(most common>60)=mostly B/L,with B=cells choricarcinoma(placenta like)=syncyto and cyto trophoblasts (can invade to blood on early stage) absent villi

embryonal carcinoma=imature primitive cells on macroscopy=haemorrhage and necrosis is present

teratoma (AFP). is composed of at least 2 embryonic layers as mesoderm (cartilage) and ectoderm (epith. and hair) . It is almost malignant in males and usually benign in females . It is more common in females

• Embryonal carcinoma .
  Is malignant germ cells tumour .
  Is immature primitive cells that may produce GLANDS
  Found in testis and epididymis .
  Is aggressive tumor with early metastasis (60%) .
  C/O is {AINLESS SWELLING .
  Macroscopic is hemorrhagic mass with necrosis
• choriocarcinoma . Is PLACENTA-like tissue with absent villi .
  Is aggressive tumour with early blood metastasis
• Seminoma(LSH) . Is the most common testicular tumour. Is germ cell tumour .
  Has good prognosis if detected early .
  Microscopic has large cell with clear cytoplasm and central neucli
• testicular lymphoma . Is the most common testicular tumour in men over 60 . Bilateral is common 40% . Usually consist of large B cells

Question 5

Polydypsia, lethargic, depression and constipation
in pt with hx of prostate cancer&raquo_space;» think about metastatic bone cancer
Prostate cancer metastasis&raquo_space;> commonly to spine and pelvis

Answer 5

Investigation is Serum calcium

Tx is Bisphosphonates Dronates

Question 6

Sub mandible mass

Answer 6

Any patient presenting with neck mass&raquo_space;>
the Aim to know it is Benign or Malignant.

• the initial inx. of the neck mass is US then FNAC.
• After the result of FNAC, CT or MRI will be done to assess the mass bulk and local and distal invasion
• no role of x ray neck
• CT and MRI are not the initial inx. for neck masses