Oncology

Question 1

what is the difference between stage 2 and 3 in the WHO performance status for cancer patients?

Answer 1

both stages are symptomatic

stage 2: < 50% of time spent in bed. up and about >50% of waking hours

stage 3: > 50% of time spent in bed or in chair

Question 2

what WHO status is a cancer patient who is asymptomatic?

Answer 2

stage 0

Question 3

which 3 organs are most affected by chemotherapy toxicity?

Answer 3

kidneys

liver

ears

Question 4

why does constipation occur in chemotherapy treatment?

Answer 4

due to autonomic neuropathies caused by the chemotherapy

Question 5

name the 3 lines of medication used to treat patients at high risk of chemotherapy induced N&V?

Answer 5

1. dexamethasone
2. ondansetron (5HT3 antagonist)
3. apreptide

Question 6

what can be used for breakthrough N&V in chemotherapy?

Answer 6

metoclopramide or ondansetron

Question 7

what can be given for anticipatory N&V in chemotherapy?

ie- in response to certain sites or smells?

Answer 7

lorazepam

Question 8

what long term side effect in radiotherapy can affect the lungs?

Answer 8

pulmonary fibrosis

causes SOB

develops months to years after Tx

Question 9

what 2 things cause neutropenic sepsis?

Answer 9

marrow failure due to :

• malignancy
• chemotherapy

Question 10

what gram negatives are most commonly associated with causing neutropenic sepsis?

Answer 10

E.Coli, klebseilla

Question 11

what AB is given 1st line in neutropenic sepsis?

what additional medication is added if NEWS >7?

Answer 11

tazocin

if NEWS >7, also give gentamicin

Question 12

which type of cancer is most likely to cause superior vena cava obstruction?

Answer 12

renal cell carcinoma

Question 13

what is tumour lysis syndrome?

Answer 13

the syndrome that occurs following rapid destruction of the malignant cells in response to chemotherapy

this rapid cell breakdown causes electrolyte imbalances

Question 14

describe the electrolyte imbalances seen in tumour lysis syndrome?

Answer 14

hyperkalaemia

hyperuricemia

hyperphsophatemia

hyPOcalcemia (the only one that is low)

Question 15

which 2 situations is tumour lysis syndrome most commonly seen?

Answer 15

haematological malignancies

very chemo sensitive tumours

Question 16

what are the 3 main manifestations of the electrolyte imbalances seen in tumour lysis syndrome?

how is it managed?

Answer 16

• AKI
• cardiac arrhythmias
• muscle cramps or cognitive decline

manage each electrolyte imbalance individually

Question 17

which 3 cancers most commonly cause spinal cord compression?

Answer 17

lung

breast

prostate

Question 18

how is spinal cord compression Ix’d and Tx’d?

Answer 18

do whole body MRI scan within 24 hours of presentation

high dose oral dexamethasone and urgent assessment for radio or surgery

Question 19

in the palliative setting, what is given 1st line for confusion?

Answer 19

haloperidol

Question 20

what is 1st line in a terminal palliative case for agitation and restlessness?

Answer 20

midazolam

Question 21

what is the palliative anti emetic of choice?

Answer 21

metoclopramide

Question 22

what is 1st line for pain relief in palliative care?

Answer 22

diamorphine

Question 23

what is 1st line for secretions in palliative care?

Answer 23

hyoscine bromide

Question 24

which tumour is associated with immunoglobulins as a form of tumour marker?

Answer 24

multiple myeloma

Question 25

name the tumours associated with:
a) CA-125

b) CA 19-9
c) CA 15-3

Answer 25

a) CA-125 - ovary
b) CA 19-9 - pancreas

CA 15-3 - breast

Question 26

which 2 cancers develop early in Lynch syndrome?

Answer 26

colorectal and endometrial cancer

Question 27

name the 3 cancers that most commonly metastasise to bone?

Answer 27

PBL

prostate

breast

lung

Question 28

name 2 organs specifically affected by methotrexate?

Answer 28

liver and lung

fibrosis occurs in both structures

Question 29

what is the major adverse affect of bleomycin?

Answer 29

may cause pulmonary fibrosis

it is a cytotoxic antibiotic

Question 30

which agent can cause agranulocytosis or myelosupression?

Answer 30

cyclophosphamide

an anklyating agent

Question 31

which cytotoxic agent can cause haemorrhagic cystitis or transitional cell renal carcinoma?

Answer 31

cyclophosphamide

Question 32

which cytotoxic agent causes ototoxicity, peripheral neuropathy and low Mg levels?

Answer 32

cisplatin

Question 33

which cytotoxic agent is most associated with peripheral neuropathy?

Answer 33

vincristine

urinary hesitancy may develop secondary to bladder atony

Question 34

which 3 HPV subtypes increase risk of cervical cancer?

Answer 34

HPV 16, 18, 33

Question 35

what drug can be given to patients at low risk of N&V symptoms associated with chemotherapy?

Answer 35

metoclopramide may be used 1st lie

Question 36

what should be given in suspected neoplastic spinal cord compression whilst awaiting investigations?

Answer 36

high dose oral dexamethasone, immediately

Question 37

which drug is given to suppress N&V with intracranial tumours?

Answer 37

dexamethasone

Question 38

which cytotoxic agent is most likely to cause cardiomyopathy?

Answer 38

doxorubicin

increasing SOB, displaced apex beat 3rd heart sound

Question 39

where is the most common site for cancers to metastasise to? ?

Answer 39

spine