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FRACP Exam > Oncology > Flashcards

Oncology Flashcards

1
Q

What part of the cell cycle does vinca alkaloids work on

A

M phase

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2
Q

What drugs are Vin alkaloids

A

Vinblastine
Vincristine
Vinorelbine

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3
Q

What cytotoxics are epipodophtlotoxin derivatives

A

Etoposide
Teniposide

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4
Q

What phase does bleomycin work on?

A

G2

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5
Q

What is the MoA of anti-metabolites? (e.g methotrexate, cytarabine)

A

Mimic normal cell components ( in S phase) to inhibit DNA replication

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6
Q

What are pyrimidine analogue?

A

Capcitabine
Cytarabine
Gemcytabine
Fluouracil

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7
Q

What phase of the cell cycle does Capecitabine work on?

A

S Phase

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8
Q

What cytotoxics cause pulmonary fibrosis

A

Bleomycin
Cyclophosphamide

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9
Q

Side effects of cyclophosphamide

A

Anorexia, cardiotoxicity, interstitial pulmonary fibrosis, bladder cancer

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10
Q

What TKI are for BRAF mutation? (Met melanoma)

A

Dabrafenib, Vemirafenib
(80% of people will develop resistance)

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11
Q

What TKI are for MEK mutation in Met Melanoma?

A

Use BRAF inhib (Vemirafenib/Dabrafenib) AND Trametinib

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12
Q

What are SE if Dabrafinib/Vemirafenib + Trametinib?

A

Fever, drenching swears, tachycardia, rash, pruritis, photosensitivity (Vemirafenib)
HTN

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13
Q

What is the only CTLA-4 inhibitor?

A

IPILIMUMAB

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14
Q

Side effects of Cobimatinib?

A

Acneiform rash

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15
Q

Side effects of CTLA-4?

A

Clinically significant toxicity in 20%
- GI toxicity/Colitis

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16
Q

Are endocrinopathies more common in PD1 or CTLA4?

A

PD-1 inhib - nivolumab

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17
Q

What are side effects of alkylating agents ( e.g cyclophosphamide)

A

Bone marrow depletion, N. V, late cancers.

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18
Q

What is the MoA of Alkylating agents?

A

Prevent cell division, cross linking , prevent DNA synthesis leading to programmed cell death

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19
Q

What are the side effects of Anthracyclines? (Doxorubicin, daurubicin)

A

Cardiotoxicity, myelosuppression, alopecia

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20
Q

What is the MoA of Doxorubicin?

A

Multiple MoA: Free-radical formation, lipid peroxidation, direct membrane effects, enzyme interactions.

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21
Q

What are the side effects of etoposide?

A

Diarrhoea, mucositis, nausea

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22
Q

What is the medianism of action of Topoisimerase II inhibitors?

A

Inhibits the enzyme that manages the coiling of DNA leading to accumulation of cleaved DNA stand breaks and cell death

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23
Q

What are side effects of mitotic inhibitors ( vincristine)

A

Neurotoxicity, myelosupression

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24
Q

What is the MoA of Mitotic inhibitors?

A

Blocks microtubule formation presenting formation of the mitotic spindle (M-phase)

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25
Q

What are the common mutations in melanoma?

A

BRAF (40-60%), 80-90% of these are V600E, eventually if treated with BRAF TKI will develop MEK mutation

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26
Q

How can you tell if a dMMR in a colorectal cancer is somatic or germline?

A

If BRAF V600E found then can assume there is acquired MLH1 hypermethylation CRC. BRAFV600e only in <1% lynch syndrome (only applicable in CRC)

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27
Q

What are the histological features of dMMR/ lynch syndrome

A

Mucinous histology, poor differentiation, right sided, lymphocytic infiltrate, absence of intraglandular neutrophil necrosis

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28
Q

What are the dimerised pairs for dMMR on immunohistochemistry

A

MLH1 and PMS2 = indicate dysfunctional MLH1 protein production
MSH2 and MSH6 = indicate dysfunctional MSH2 protein production
Isolated loss of PMS2, or MSH6

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29
Q

What are causes of MLH1 gene dysfunction?

A

Hypermethylation MLH1
Somatic tumoural pathogenic variant
Gernline pathogenic variant

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30
Q

Do dMMR respond to immunotherapy?

A

Mismatch repair is a good indicator for response to immune checkpoint inhibitors

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31
Q

What is Ca125

A

Marker of ovarian cancer
Inc in 80% advacned epithelial ovarian ca.

32
Q

Can you use Ca125 as a screening tool?

A

No <50% increased at atge 1

33
Q

What can cause elevation of Ca125?

A

Advanced ovarian Ca, breast, colon, lung cancers, Mentruation , endo, fibroids, liver disease, diverticulitis

34
Q

Whats the most common ovarian cancer?

A

Surface epithelium ( 85-90%)
- Serous - 50%
High grade serous
- Mucious 10-15%
Endometroid
Clear cell

35
Q

Treatment of III-IV epithelial ovarian cancer?

A

Debulking Surgery + Chemo (Platinum + taxane, carboplatin + paclitaxel)

36
Q

What is olaparib?

A

PARP inhibitor - used in BRCA + ovarian and breast Ca - cell death by synthetic lethality
Parp repairs single stranded DNA breaks

37
Q

What ovarian cancer should always undergo BRCA testing?

A

High grade serous

38
Q

Side effect of paclitaxel?

A

Neuropathy

39
Q

Side effect of doxorubicin?

A

Irreversible cardiotoxicity by apoptosis of cardiomyocytes

40
Q

Which testiculat cancer DOESN’T produce AFP?

A

Pure seminoma

41
Q

Side effects Bleomycin?

A

Cough, stretch marks, blistering, alopecia, mucositis

42
Q

Cisplatin side side effects

A

Highly emetogenic, delayed emesis, renal impairment
Ototoxicity
Peripheral neuropathy

43
Q

What enzyme deficiency is dangerous in fluropyrimidine use?

A

Dihydropyrimidine dehydrogenase deficiency - inability to metabolise 5FU - can lead to fatal toxicity
Early mucositis and myelosupression

44
Q

What would you see in someone with dihydropyrimidine dehydrogenase deficiency if given 5FU?

A

Early myelosuppression and severe mucositis.

45
Q

What are the toxicities of fluropyrimidines?

A

5FU/Capcitebine
- Mucositis
- Diarrhoea
- N + V
- Coronary artery vasospasm
- Myelosuppression

46
Q

What are the side effects of irinotecan?

A

diarrhoea
Myelosuppressino
Fatigue
Topoisomerase inhib

47
Q

What are the side effects of Oxaliplatin?

A

Peripheral neuropathy, cold dysaethesia, fatigue, infusion reactions

48
Q

What deficiency is important in use of irinotecan?

A

UAT181 deficiency (seen in gilberts syndrome) - can lead to fatal toxicity

49
Q

What is required to use EGFR inhibitors (cetuximab) in CRC and why?

A

Must be RAS/RAF/HER2 wild type - because these are downstream in the MAPK pathway so inactivation of the TKI will do nothing.

50
Q

What targeted therapy is used if there is BRAF/RAS mutation in CRC?

A

VGEF inhibitors - bevacizumab
Also used in R) CRC

51
Q

Who should have bowel screening prior to age 50?

A
  • 2 first degree relatives with CRC
  • One first degree relative <50 w CRC
  • Personal Hx CRC
  • Familial coloractal cancer syndrome
52
Q

What bacteria is associated with colon cancer?

A

Strep Gallolyticus ( prev S.Bovis)

53
Q

What is the pattern of inheritance of HNPCC?

A

AD with high penetrance.

54
Q

What does APC gene deletion give

A

FAP - Autosomal dominant inheritance and high penetrance.
CRC by age 40

55
Q

What is the pattern of inheritence for MUTYH associated polyposis?

A

AR

56
Q

How many nodes are required to be removed to be considered adequate in CRC resection?

A

12-14

57
Q

What is microsttellite instability?

A

Large repeat sequences of DNA

58
Q

BRAF, EGFR, ALK, HER2 BCR-ABL mutations are tumour suppressor genes or oncogenes?

A

Oncogene / mutation = oncogene addiction

59
Q

Which has higher risk of VTE Tamoxifen or letrozole ( aromatase inhibitors)

A

Tamoxifen has increased risk VTE + Increase risk endometrial cancer
Tamox - Tumours and thrombosis

60
Q

What risk is increased with use of letrozole compared to tamoxifen?

A

Osteoporosis
(Used in post-menopausal old ass osteoporotic ladies)

61
Q

What chemotherapy agents cause hand-foot syndrome? (palmer-planar erythrodysesthesia)

A

5FU, Doxorubicin

62
Q

What is the cause of chestpain in someone on a 5FU infusion?

A

Coronary vasospasm - stop the infusion

63
Q

how many lymph nodes need to be resected to say node negative for CRC?

A

minimum 14

64
Q

What is the (RACP) conversion ratio of PO morphine to SC morphine?

A

2:1 (divide PO dose by 2 to get the SC dose)

65
Q

What is the (RACP) conversion of Morphine to oxycodone?

A

2:1 ( 20mg morphine = 10mg oxycodone)

66
Q

Where does colon cancer metastasize first?

A

Liver

67
Q

Where does rectal cancer met first?

A

Lung (rectum drains by IVC)

68
Q

What are further treatments after resection gorT3-4 rectal cancer?

A

Long course chemoradiotherapy - due to risk of local recurrence being high

69
Q

What side of the colon does FAP more often get CRC?

A

Left,
MUYT associated get Right sided

70
Q

What molecular pathway is most comonly mutated in right colorectal cancers?

A

BRAF

71
Q

What type of cancer is spindle cells in?

A

GIST

72
Q

What is the treatment of GIST?

A

Tumour <10cm - resect if not metastatic
+ imatinib
If metastatic = imatinib alone

73
Q

What is the RACP conversion of SC to PO morphine?

A

1mg SC = 3mg PO

74
Q

What is the conversion of hydromorphone to morphine ( PO and PO )

A

1mg hydromorphone = 7.5mg morphine

75
Q

What is the important mutation in GIST tumours?

A

cKIT

76
Q

Other than CRC what cancers are inc risk in HNPCC?

A

Endometrial + pancreatic

FRACP Exam (15 decks)

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