Oncology Flashcards
Colonic cancer staging
Colonic cancers are staged with CT scanning of the chest, abdomen and pelvis.
Rectal cancer staging
MRI of rectum and CT of chest, abd and pelvis.
Goldstandard for Colorectal Ca
Colonoscopy is the gold standard,
What is NHS BOSS flexible sigmoidoscopy screening?
The NHS BOSS flexible sigmoidoscopy screening comprises a single flexible sigmoidoscopy to patients aged 55 years
what signs warrant a referral for rectal ca
Essentially the following patients need referral:
- Altered bowel habit for more than six weeks
- New onset of rectal bleeding
- Symptoms of tenesmus
Tumor marker for Colorectal Ca
Carcinoembryonic antigen (CEA) is the main tumour marker in colorectal cancer.
Most hypervascular metastatic cancer
Renal metastases have a tendency to be hypervascular.
TUmours that spread to bone
The typical tumours that spread to bone include:BBRTP
Breast
Bronchus
Renal
Thyroid
Prostate
What is Mirel scoring system
Mirel Scoring system for fracture
Score pointsSiteRadiographic appearanceWidth of bone involvedPain1Upper extremityBlasticLess than 1/3Mild2Lower extremityMixed1/3 to 2/3Moderate3PeritrochantericLyticMore than 2/3Aggravated by function
chemotherapy in breast Ca
Patients with grade 3 lesions or axillary nodal disease
*To downsize the tumor
Endocrine therapy in Breast Ca
*Postmenopausal :Aromatase inhibitor like letrozole.
*Perimenopausal:Tamoxifen for 3years then switchto letrozOlle
*Premenopausal: Exemestane over tamoxifen.
Chemotherapy for Breast Ca
FEC regime is most commonly used (Fluorouracil, epirubicin and cyclophosphamide).
Raised CEA levels in non malignant situations
Cirrhosis
IBS(Thus not used for screening of Ca in colitis patients)
Diseases which require Colorectal Ca screening
*Familial adenomatous polyposis
*Hereditary non polyposis colorectal cancer
* Peutz Jegher Syndrome
*Acromegaly
*IBD
*Ureteosigmoidostomy
Most common osteolytic bone metastatic in children
Neuroblastoma
site of Bone# in Ca
The commonest bone sites affected are:
Vertebrae (usually thoracic)
Proximal femur
Ribs
Sternum
Pelvis
Skull
What to do in doxorubicin extravasation
cold compresses is indicated in doxorubicin extravasation
Hyaluronidase is indicated in the extravasation of???
Hyaluronidase is indicated in the extravasation of
contrast media
TPN
vinca alkaloid
FNAC can’t diagnose which thyroid tomer
Follicular Tumor
Mainside effect of arthracyclines(doxorubicin)
Cardiotoxicity
Breast ca drugs
Class. Example. Mode of action
Antimetabolites. 5 FU. S Phase specific drug, mimics uracil and is incorporated into RNA
Anthracyclines.* Doxorubicin. Inhibits DNA and RNA synthesis by intercalating base pairs
Topoisomerase inhibitors.** Etoposide. Inhibits topoisomerase II, prevents efficient DNA coiling
Platinum. Cisplatin. Crosslinks DNA, this then distorts molecule and induces apoptosis (similar to alkylating agents)
Alkylating agent. Cyclophosphamide. Phosphoramide mustard forms DNA crosslinks and then cell death
Taxanes. Docetaxal. Disrupts microtubule formation
Drugs for pain in CKD patient
Alfentanil, buprenorphine and fentanyl are preferred
Contraindication to Iung cancer excision
Assess general health
Stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
Criteria of adrenalectomy
if the tumor is producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters).
Mostcommon thyroid Ca
Papillary Carcinoma
Feature of papillary ca of thyroid
Histologically, they may demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei
Papillary projections with pale nuclei
Lymph nodal Spread
pMostly non capsulated
Mostcommon thyroid Ca In elderly females
Anaplastic Carcinoma
Common age group of testicular torsion
Most common in males aged between 10 and 30 (peak incidence 13-15 years)
FNAC for thyroid
Accurately diagnose papillary Ca
Don’t diagnose follicular so if follicles on FNAC the have to perform hemithyroidectomy
Medullary Carcinoma of thyroid is present in
MEN -2A disease spectrum.
Thyroid Ca not reacting to radioiodine therapy
Medullary Carcinoma as it is derived from neural crest cells and not from thyroid tissue
Sarcoma spreads across
Fascial planes and metastasized via blood most commonly to lungs
Rhabdomyosarcoma and angio sarcoma spreads through
Lymphatics
Which structures are resistant to invasion by a sarcoma
Major nerve sheets
adventitia of large vessels and fascia
Familial melanoma genes
CDKN2A, BRCA1 ,CDK4 genes
PCKD is associated with
Intracranial aneurysms, rend failure and cyst formation
Ciclosporin causes
Ciclosporin- nephrotoxicity
azathioprine side effects
myelosupression, alopecia and nausea
Drugs used as immunosuppressants after transplant
Cyclosporin and tacrolimus are commonly used drugs.
Tacrolimus side effects
However, high incidence of impaired glucose tolerance and diabetes
Mycophenolate mofetil (MMF) MOA
Blocks purine synthesis by inhibition of IMPDH
IL 2 receptors inhibitor immunosuppresants
- Monoclonal antibodies
Daclizumab
Basilximab - Sirolimus (rapamycin)
PVC / Vinyl chloride causes which cancer
Angiosarcoma
Shift work has been linked to which Ca in women
breast cancer in women
Latency period between exposure and disease for solid tumors versus leukemia
The latency between exposure and disease is typically 15 years for solid tumours and 20 for leukaemia.
Schistosomiasis feature
More in Ghana
If turned to Ca then it will be squamous cell carcinoma
Most common bladder Ca
transitional cell carcinoma
aromatic hydrocarbons (e.g. industrial dyes or rubbers), can cause which Ca
Bladder Ca
Painless haematuria
Bladder Ca
If suspected bladder cancerm perform
Urgent cystoscopy
Bladder cancer can be caused by which type of chemicals
Aniline dye
Synthetic rubber
Beta naphthiline
Benzadine
Transitional cell bladder tumor versus squamous cell
Transitional cell has papillary growth while squamous cell has solid growth
Transitional cell has good prognosis while squamous cell has bad prognosis
Cholinergic syndrome caused by which cancar med
=Irinotecan
Cardiotoxic anti Ca agents
5_FU an antimetabolie
Doxorubicin an anthracycline
Side effects of Cisplatin
Kidney failure
Ototoxicitty
Peripheral neuropathy
Which anti Ca drug Crosslinks DNA
Cisplatin
Hemorrhagic cystitis is caused by
Cyclophosphamide
Which agents cause pulmonary fibrosis
Cyclophosphamide
Methotrexate
Bleomycin
Drugs which are M phase specific vs S phase specific
Vince alkaloids vs Antimetabolites
Vincristine is used for
Lymphoma
Neuroblastoma
Rhabdomyosarcoma
Which drug inhibit microtubule formation
Taxanes
Sudden total alopecia is caused by
Taxane I.e pacilitaxel
Side effects of paclitax3l
Sudden total alopecia
Myalgia
Peripheral neuropathy
Which drug causes alopecia
Taxanes
Mitomycin C
Pancreatic cancer tumor marker
CA 19-9
