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RACP > Oncology > Flashcards

Oncology Flashcards

1
Q

Treatment Mesothelioma

A

Nivolumab - PD-1 inhibitor
Ipililumab - CTLA4 inhibitor
Not curative, only improves survival by 4 months

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2
Q

Side effect of GnRH Agonist

A

Early increase in testosterone levels cause progression of bony mets and prostate enlargement - risk of cord compression and urinary retention

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3
Q

Side effect of Abiraterone

A

Blocks 17-hydroxylase
Increased mineralocorticoid effect
requires co-administration with steroids to reduce mineralocorticoid effect (Hypokalaemia, Hypertension, peripheral oedema)

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4
Q

Hormonal therapy in ER/PR positive women

A

Pre-menopausal - Tamoxifen
Post-menopausal - Aromatase inhibitors - block androgen conversion to oestrogen (can cause progression in pre-menopausal women)

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5
Q

EGFR mutation in lung cancer

A

Asian women, non-smokers with adenocarcinoma - treated with EGFR tyrosine kinase inhibitors Rx with Gefitinib and erlotinib
If EGFR T790M resistant, use Osemertinib

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6
Q

T790M resistance mutation of lung cancer

A

EGFR T790M resistance to EGFR TKI Gefitinib and erlotinib, requires Osemertinib

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7
Q

Mutations in CRC

A

Germline;
- Lynch Syndrome - DNA mismatch repair (MLH1, MSH2, PMS2, MSH6)
- Familial adenomatous polyposis - adenomatous polyposis gene on chromosome 5

Somatic;
- BRAF - methylation causing DNA mismatch repair - R) sided with poor prognosis
- KRAS
- EGFR (BRAF/KRAS wild type) - L) sided with good prognosis

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8
Q

Aromatase inhibitors

A

Used in hormone receptor positive breast cancers in post-menopausal women only

Side effect: Osteoporosis, vaginal atrophy

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9
Q

Tamoxifen

A

selective oestrogen receptor modulator (SERM) for hormone receptor positive breast cancer.
Causes thrombosis, hot flushes, increased risk of endometrial cancer

Should not be used with paroxetine or fluoxetine (CYP inhibition)

Has positive effects on bones and lipid profile

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10
Q

HER2 inhibition

A

Trastuzumab - can cause cardiotoxicity
Lapatinib - preferred if EF < 45% or known brain mets

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11
Q

Cell cycle

A

G0 - Quiescent state

Interphase
G1 - protein and cell contents replication, except DNA
S - DNA replication
G2 - Microtubule production

Mitosis - cell division
Cytokinesis

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12
Q

Best tumour marker for monitoring disease

A

Beta-HcG or AFP in testicular cancer

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13
Q

Treatment of ovarian cancers

A
  1. Debulking surgery
  2. Platinum based chemotherapies with Paclitaxel + Carboplatin
  3. PARP inhibitor - Olaparib
  4. Genetic testing for BRCA in all ovarian cancers
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14
Q

Most common renal cell carcinoma

A

Clear cell due to Von-Hippel Lindau mutation
Originate from Proximal convoluted tubule
Treat with IL-2

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15
Q

Types testicular cancer

A

Seminoma
- Beta HcG
- Responsive to radiotherapy

Non- Seminoma
- AFP and Beta HcG
- Non-responsive to radiotherapy

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16
Q

Management Testicular cancer

A

Low risk
- Radical Orchidectomy followed by active surveillance;
1st year monthly., 2nd year 2 monthly, 3rd year 3 monthly, 4th year 6 monthly - Then yearly.
- If patient non-compliant with F/U use Cisplatin Chemo

High Risk
- Radical orchidectomy
- BEP chemotherapy - Bleomycin, Etopocide, cisPlatin
- Radiotherapy for seminoma only

17
Q

p53

A

Tumour Supressor Gene - arrests cell cycle in G1 to allow for DNA repair or programmed cell death

If mutated, prevents DNA repair and drives cancer

In B cells - p53/17p deletion drives CLL, Rx Ibrutinib

18
Q

Mutation associated with clear cell renal cancer

A

Von Hippal Lindau (VHL)

19
Q

Side effect of VGEF inhibitors

A

I.e Bevacizumab in BRAF/KRAS mutant CRC
I.e. Sunitinib in renal cancer

Hypertension

20
Q

Treatment for prostate cancer

A

If castrate sensitive - for androgen deprivation therapy
- GnRH agonists (Groselin)-> can flare before improvement
- GnRH antagonists (Degarelix)
If castrate resistant
- Taxel based chemo -> ototoxicity
- 17-hydroxylase inhibition - Abiraterone -> Mineralocorticoid production Rx w Pred
- Androgen receptor antagonist - Enzalutamide

21
Q

Breast cancer screening

A

Mammography every 2 years from 50-74 years of age
If BRCA positive, mammography or USS every 2 years from age 25, or 5 years before youngest affected relative

22
Q

BRCA screening

A
  • Any (Non-mucinous) ovarian cancer Dx < 70 years, or any age if personal or FHx of breast cancer w ovarian cancer
  • triple negative breast cancer < 60 years of age
  • breast cancer < 40
  • Manchester score > 15
  • Ashkenazi Jewish population
23
Q

BRCA treatment

A
  • Platinum base chemotherapy
  • PARP inhibitors (Olaparib)
  • Salpingoopherectomy
  • Contralateral mastectomy
24
Q

Side effect of Trastuzumab

A

Cardiotoxicity with reduced LVEF

25
Q

Mutations associated with NSCLC

A

EGFR (Gefitinib/erlotinib) > ALK (Alectinib) > ROS1 (Crizotinib)

+/- check for PDL status (Nivolumab/pembrolizmab/Atezolizumab +/- Ipalilumab CTLA4 inhibition)

26
Q

Types of chemotherapy

A

Alkalysing agents - inhibit unfolding DNA helix - “Platins”

Anti-metabolites - 5FU (Check DPD), 6-MP (check TPMT)

Alkaloids - inhibit microtubules - Vincristine, Taxels

Topoisomerase inhibitor - etoposide, Anthramcyclins - Bleomycin (from streptomycin), Doxorubicin, cyclophosphamide

27
Q

Cisplatin side effects

A

Neuropathy, Ototoxicity, metabolic syndrome and Nausea (most highly emetogenicity)

28
Q

Lynch Syndrome

A

Germline mutation in Mismatch repair genes causing Microsatellite instability (MLH1 - highest risk, MSH2, PMS2, MSH6)
BRAF mutant
Autosomal dominant inheritance

29
Q

BRCA 1 vs 2

A

BRCA 1 is more common and most likely to be associated with;
- Medullary breast cancers
- Serous ovarian cancer (mucinous ovarian cancer not associated with BRCA)
- Prostate cancer in Men
- Triple negative

BRCA2
- increased risk of breast cancer in males
- hormone receptor positive breast cancer

30
Q

Chemotherapy for breast cancer

A

Doxorubicin and cyclophosphamide

31
Q

Non-chemo treatments for breast cancer

A

Trastuzumab - HER 2 +
Tamoxifen - SERM - ER/PR + pre and post menopausal
Aromatase inhibitors - PR/ER+ post menopausal
CDK 4/6 - Abemaciclib - PR/ER + metastatic breast cancer
T DM1 - Trastuzumab plus chemotherapy (emtansine/DM1) - HER 2+

32
Q

GIST tumour

A

From cells of Cajal
Associated with KIT-C CD117 (same as melanoma)
Spindle cells

33
Q

FOBT screening

A

2 yearly over age 55

34
Q

Bowel cancer screening - Moderate risk

A

Colonoscopy every 5 years or 10 years before age first affected relative

35
Q

Bowel cancer screening - Lynch and FAP

A

Lynch - colonoscopy yearly from 25 or 5 years before first relative
AFP - colonoscopy yearly from age 15

RACP (17 decks)

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