Oncology Flashcards
Polyp type with highest risk of malignant transoformation
Villous
Treatment of mCRC with MSI
PD-1 therapy
Treatment of mCRC wild type RAS/BRAF
FOLFOX chemo + EGFR inhibitor (cetuximab)
Treatment of mCRC with mutant RAS/BRAF
FOLFOX chemo + VEGF inhibitor (bevacizumab)
A/E EGFR inhibitors
Acneiform rash
A/E bevacizumab
Impaired wound healing
GI perforation
MoA of irinotecan
Topoisomerase inhibitor
A/E of 5FU/Capeceitabine
Hand foot syndrome = palmar, plantar erythrodesia
Coronary vasopasm
Prior to using 5FU/capecitabine, check?
DPD (dihydropyrmidine dehydrogenase) - lack this, cannot metabolise, get significant myelosuppression
Metastatic malignancy, acute SOB, unexplained, CXR shows bilateral infiltrates
Suspect?
Lymphangitis carcinomatosis
Metastatic malignancy, acute SOB, features R heart strain with hypoxia, clear lungs
Suspect?
Pulmonary tumour embolism
Ki-67 - overactivity?
Cell proliferation
Ki-67 inhibition
inactivation of ribosomal RNA synthesis
SERM for breast cancer - which cell cycle phase
G1
Mammography underestimates which type of breast cancer?
Lobular
Breast cancer type that recurs after 10 years
ER positive
Breast caner type with bone mets
ER positive
Breast cancer type with brain mets
HER2 positive
EGFR (epidermal growth factor) receptor
- intracellcular signalling pathways (2)
Ras –> Raf –> MEK –> erk
- CRC check for RAS and RAF
- Melanoma - check for RAF and MEK
Pi3 –> MTOR
- Breast cancer - use CDK inhibitors first, then Pi3 inhibitors, then mTOR
Angiogenesis growth factors
VEGF
Platelet derived growth factor
Fibroblast growth factor
Where do Cyclin dependant kinase inhibitors act on?
G1/S phase
Epigenetics
- Anti-cancer treatments based on this
Hypomethylating agents
- Azacitidine for high risk MDS
Histone deacetylase (HDAC) inhibitors
- Vorinostat used in cutaneous T cell lymphoma
Vorinostat
- MoA
- Use
HDAC inhibitor
Cutaneous T cell lymphoma
2nd line neuroendocrine tumours?
Radiolabelled somostatin analogues
–> Peptide receptor radionucleotide therapy (PRRT)
MSI on CRC
- What differentiates Lynch (germline) from Sporadic
Sporadic may have BRAF mutation
Lynch will note have BRAF
Genetic defect in MUTYH associated polyposis
Deficient base excision repair
Pairs of mismatch repair proteins
MLH1 and PMS2
MSH2 and MSH6
Management of met CRC?
MSI? - PD1 single agent
Otherwise FOLFOX/FOLFIRI chemotherapy with:
- RAS/RAF wildtype - cetuximab (EGFR inhibitor)
- RAS/RAS mutant - bevacizumab (VEGFR)
- HER2 over-expressed - HER2 inhibitor
What is border of R sided vs L sided CRC
Splenic flexure. After splenic flexure = L, Before = R
CRC staging
- Into muscularis propria but not through
T2
CRC staging
- Limited to mucosa and submucosa
T1
CRC staging
- Invasion through muscularis propria
- Into peritoneal cavity
Through - T3
Into periteonal cavity - T4
Biggest predictor of CRC recurrence?
Lymph node sampling
BRAF inhibitor in mCRC
- Agent?
- When to use
Encorafenib
mCRC. RAS wildtype, BRAF mutant.
Can use cetuximab and ecorafenib, with idea BRAF inhibitor may overcome EGFR resistance
Spindle shaped cells
GIST
Kit-117
GIST
Gene for diffuse gastric cancer
CDH1
Hereditary diffuse gastric cancer
- cancers
- inheritance and cause
Germline mutation in CDH1 –> autosomal dominant
Signet ring cell gastric cancer and lobule breast cancer
Which gland of prostate are majority of prostate cancer cases?
Posterior gland
Significance of gleason score
x2 core biopsies of prosate. Grades differentiation out of 5, adds two score together.
6 or less is grade 1, very unlikely to metastasise (however can be sampling error)
1st line for met castrate sensitive prostate cancer
ADT + docetaxel + androgen receptor antagonist
Can not use docetaxel if not candidate for chemotherapy
1st line for nonmetastatic castrate resistant prostate cancer
Continue ADT
Add androgen receptor inhibitor
1st line for metastatic castrate resistance prostate cancer
- Rapd
- Slow
Rapid - Continue ADT + add taxane
Slow - continue ADT and add novel anti-androgen/abiraterone
2nd line for met castrate resistant prostate cancer after failure of anti-androgens and taxane
PMSA Lu-117
A/E abiraterone
Adrenal insufficiency with lack of gc but mineralocorticoid excess (blocks 17a hydrooxylase)
Give concurrent prednisolone
A/E enzalutamide
Increased risk falls and fractures
ADT A/E
- Most common
- Others
Most commmon - sexual dysfunction
Others
- Osteoporosis
- CVD and diabetes
- weight gain
- Cognitive dysfunction
Most common melanoma
Superfiical spreading
Melanoma with best prognosis
Superficial spreading
Tan/brown macule, older person, sun exposed area
Lentigno melanoma
Palms/plantar/subungual melanoma
Acral lentignous
Nodule with pink hue, melanoma
Nodular
Protective for CINV?
ETOH
Adjuvant beneficial agent for CINV
Olanzapine - can add to triple regimens
BRCA 2 higher risk of?
Male breast cancer
Prostate
BRCA 1 higher risk of?
Breast cancer
Ovarian cancer
(female)
When to require axillary clearance in breast cancer
> 2 sentinel nodes positive
Target membrane protein in refractor breast cancer conjugated to topoisomerase inhibitor
TROP-2
Most common immunotherapy A/E
Skin
Which immunotherapy has more common/severe A/E
CTLA4
- Hypophyisitis
- Pulmonary toxicity
Which type of thyroid illness more common with immunotherapy
hypothyroidism
When to use PJP PPx for patients receiving corticosteroids for IrAE
Concurrent chemo
Underlying lung conditions
> 6 weeks steroids/complicated A?E
Requirements prior to using Fleischner guidelines for incidental pulm nodules
Age > 35
Baseline risk (i.e not screening)
Not immunocompromised
No history malignancy previously treated/followed up
No symptoms
Single nodule
Benign characteristics no f/u requried
Fat appearance
Characteristic calcific appearance (harmatoma, granuloma)
Pulm nodule > 8mm
CT 3 months or PET
Pulm nodule < 6mm
No f/u
Pulm nodule 6-8mm (solid or cystic)
CT 6-12 months
What suggest malignant pulm nodule
Growing >2mm at seria CT
Stable pulm esion
Stable size > 2 years
4t’s anterior mediastinal mass
Thymoma
Teratoma
Thyroid
Terrible lymphoma
Pharm management for hot flushes 2nd to tamoxifen
Venlafaxine
Avoid fluox/parox due to CYP2D6 interaction
Breast cancer histopath with poor prognosis
Micropapillary
Indications for mastectomy rather than wide local excision of early breast cancer
Multicentric
Large tumour
high ris features
CI to radiotherapy (previous RT etc)
Predictive assay for early breast cancer
- tool that can be used to decide if adjuvant chemo needed
OncotypeDX Rs
1st line therapy for met ER positive brast cancer
Premenopause - Tamoxifen + CDK4/6 inhibitor + ovarian function suppression
Post-menopausal - aromatase inhibitor + CDK4/6 inhibitor
2nd line for met ER positive breast cancer
Fulvestrant
Pi3 inhibitors - idealialisib
mTOR inhibitors
1st line for met HER2 + breast cancer
Trastuzumab +/- pertuzumab
AND
Taxane chemo
2nd line for HER2 met breast cancer
T-DM1 - trastuzumab emtansine
3rd line for met her2 breast cancer
Lapatanib/capecitabine
Triple negative breast cancer options
BRCA- PARP
PD1 - immunotherapy
When to commence bone modifying agents in met breast cancer
When first evidence of bone metastasis
Considerations prior to pulmonary resection for lung cancer
Predicted pulmonary function
Baseline FEV1 and DLCO, and volume of lung to be resected
NSLC TNM staging
M = stage 4
N - contralateral mediastinal = IIIB, ipsilateral mediastinal = IIIA
Local nodes = limited disease
SCLC - when to use radiotherapy to chest?
If limited disease - tumour only, or local lymph nodes
Any mediastinal lymph nodes precludes as involves too big a RT field
Most common cause cancer death
Lung cancer
Situations where IPC is better than talc pleurodesis
Life expectancy >2 weeks but < 2 months
Not wanting any inpatient stay
Beware the man with glass eye and large liver
Ocular melanoma metastases to liver
Single enlarge lymph node
or
Enlarge lymph nodes >3cm
Castleman’s disease
Cytokine associated with castleman’s disease
IL-6
Virus associated with multicentric castleman’s
HHV-8
Metabolic changes cachexia
Catabolic
- Hypertriglyceridaemia
- Hypergylcaemia
Opioid tolerant
Breakthrough acute opioid pain
S/L fentanyl
Cancer screening program - indicator of effectiveness?
Cancer mortality