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RACP > Oncology > Flashcards

Oncology Flashcards

1
Q

vincristine, etoposide, oxaliplatin and paclitaxel are all recognised to cause neuropathy, oxaliplatin causes a classic acute sensory neuropathy that is aggravated by cold. It is thought to result from a specific interaction of oxaliplatin with voltage-gated sodium channels.

A
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2
Q

What is the leading cause of death in testicular cancer survivors?

A

Second primary cancers
- atleast 2 x increase risk of developing solid tumours
- persists at least 30yrs post treatment

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3
Q

Idosfamide

A

Synthetic structural isomer of Cyclophosphamide
- used in germ cell testicular cancer and some sarcomas

**Nephrotoxicity due to direct tubular injury **is a prominent complication

Tubular dysfunction:
- glucosuria
- Aminoaciduria
- proteinuria (LMW protein)
- increase in beta2microglobulin excretion
- DI –> polyuria

  • Hypophosphatemia: reduced prox. tubular reabsorption
  • Hypokalaemia due to wasting
  • NAGMA

Can also:
- reduce GFR

Nephrotoxicity due to ifos is due cumulative dose, age <4

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4
Q

Cetuximab

A

EGFR inhibitor
- beneficial with **BRAF/KRAS Wt and LEFT sided disease **

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5
Q

p53 staining in BRCA1 can

A

all or nothing

patchy is uncommon

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6
Q

role of VHL in normal physiology

A

suppression of HIF. HIF normally promotes angiogenesis and cell growth in hypoxic state

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7
Q

Which phase does bleomycin act on

A

G2

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8
Q

BRCA and ovarian ca

A
  • All women diagnosed with non mucinous epithelial ovarian carcinoma before the age of 70 should be tested for BRCA1 and 2
  • BRCA 2 confers a better prognosis with ovarian cancer, BRCA1 also likely does but the evidence is not as strong - this is also reflected in the effectiveness of novel PARP inhibitors.
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9
Q

standard 5-fu treatment is not effective in patients with mismatch repair deficient Colorectal cancers

A

TRUE

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10
Q

MMR colorectal cancer

A

commonly right-sided disease, mucinous Histology,
poor differentiation and lymphocytic infiltration

The majority cause MMR deficiency is due to methylation of that MLH1 gene as opposed to a germline mutations.

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11
Q

BRAF mutation in melanoma

A

more common in younger people with limited sun exposure

80% of patients in BRAF inhibitors for melanoma will develop resistance due to MAPK reactivation. One way to avoid this resistance is to combine BRAF inhibitors with MEK inhibitors.

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12
Q

“metinib”

A

MEK inhibtors

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13
Q

What is the treatment for central and peripheral hiccups in palliative pt

A

Baclofen

Metoclopramide

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14
Q

CTLA-4 inhibitors

A

Gastric toxicity

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15
Q

PD-1 inhibitor

A

endocrine

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16
Q

Gastric cancers, what’s the most commmon type?

A

Adeno

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16
Q

Gastric cancers, what’s the most commmon type?

A

Adeno

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17
Q

Most common location of gastric cancers

A

cardia then antrum

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18
Q

Hiccups are a side effect of which antemetic?

A

Aprepitant

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19
Q

Side effects of bevacizumab?

A

hypertension, proteinuria, arterial thromboembolic events and bleeding

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20
Q

Which agents affect the S-phase

A

MTX, 5FU, Gemcitabine

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21
Q

Majority of BRCA2 breast ca are

A

ER+ve

MRI screening is generally used in patients with prior radiotherapy/treatment for Hodgkin lymphoma as well as those with familial breast cancer syndromes.

Cyclin dependant kinases promote transition from G1 to S phase in cell cycle. CDK4 and 6 inhibitors such as palbociclib are used in the treatment of **hormone receptor positive metastatic breast cancer. **

The majority of breast cancer in males is estrogen receptor and androgen receptor positive.

22
Q

Anti Tr

A

Hodgkin’s disease

23
Q

Anti hu/zic4

A

SCLC

24
Q

Which factors worsens prognosis in Stage IV renal cell cancer?

A
  • Karnofsky Performance Status (KPS) <80
  • Time from original diagnosis to initiation of targeted therapy <1 year
  • Hemoglobin less than the lower limit of normal
  • Serum calcium greater than the upper limit of normal
  • Neutrophil count greater than the upper limit of normal
  • Platelet count greater than the upper limit of normal
25
Q

SE of crizotinib?

A

QT prolongation
Neutropenia
Visual changes

Fluid retention
Pulm. toxicity
Change in bowel habit
hepatotoxicity
fatigue

26
Q

Enzalutamide

A

pure androgen receptor signalling inhibitor which is used and castrate resistant prostate carcinoma

SE:
HTN
Fatigue
Seizures
SOB
Cognitive impairment

27
Q

braf v600e mutation in colorectal cancers suggests

A

sporadic mutations

28
Q

What’s the typical feature of breast cancer mets

A

Mostly lytic
25% can be mixed

29
Q

how does paroxetine and fluoxetine affect tamoxifen?

A

They are CYP2D6 inhibitors, thus reduces transformation of tamoxifen to active metabolite endoxifen.

30
Q

Which chemo may cause radiation recall reaction?

A

Daunorubicin

31
Q

RAdiation induced lung injury

A

radiation pneumonitis 4-12wks
non productive cough, exertinal dypnsoea, low grade fever, chest pain, malaise, weight loss

crackles or pleural rub

32
Q

Absolute CI to breast conservation surgery

A
  1. Persistent positive resection margin after reasonable re-excision attempts
  2. 2 or more primary tumour in separate breast quadrants
  3. Diffuse malignant appearing mammographic microcalcification
  4. A history of prior RT to the breast or chest wall
  5. Pregnancy, although possible to perform BCT in 3rd trimester, deferring RT until after delivery
33
Q

RF for RCC

A
  • Analgesic nephropathy
  • Leather tanners
  • Cadmium
  • Thorotrast
  • Acquired cystic disease
  • VHL
  • Smoking, HTN, Obesity
34
Q

Sunitinib

A

1st line for metastatic renal cell cancer
- TKI inhibitor that inhibits VEDFR, PDGFR, c-Kit (CD117), FLT-3

  • HTN is a good prognosticator for response to sunitinib
35
Q

women have higher risk for developing lung cancer for a given level of exposure to smoke than men

true or false

A

true

36
Q

Lung adenocarcinoma - associated familial mutations

A

EGFR
ALK

37
Q

Smoking increases the risk of mesothelioma

True or false

A

False

38
Q

what does fixed inspiratory wheeze indicate?

A

bronchial obstruction by tumour

39
Q

which nerve palsy causes hoarseness?

A

REcurrent laryngeal

40
Q

Which lung cancers are implicated in SVC obstruction

A

Sq.CC
SCLC

41
Q

Paraneoplastic endocrine sx with lung cancer

A

Sq. CC: PTHrP, insulin like activity
SCLC: ADH, ACTH, Carcinoid sx, ELM

Anti-hu

42
Q

Location and lung cancers

A

PEripheral - adeno
Central lesion with obstructive pneumonitis: SqCC
Mediastinal/Hilar mass: SCLC
Alveolar infiltrate: bronchoalveolar

Cavitation DOES NOT occur in SCLC

43
Q

What features on CT would suggest benign COIN LESION

A

Central or lamellar calcifications

44
Q

When are PET scan useful in lung ca

A

when lesion >1cm

45
Q

FEV1 requirement for pneumonectomy

A

FEV1 >1.5L
DLCO >80%

  • <80% –> exercise testing –> Peak VO2 <35% –> resection not recommended
    Peak Vo2 >75 –> pneumonectomy
46
Q

what is the most common symptom of lung ca

A

persistent cough
followed by breathlessness

47
Q

what do you do for immunotoxicity grade 3 that doesn’t respond to methylpred?

A

Infliximab or vedolizumab

48
Q

cisplatin ototoxicity

A

second most common SE of cisplatin
dose dependent
high frequency sensorineural hearing loss with tinnitus
- target outer hair cells in the organ of Corti and vascularised epithelium in the lateral wall of the cochlea

49
Q

which cancers contribute mostly to bone mets

A

Lung, breast, prostate

Prostate is blastic

50
Q

how does calcitonin help yo improve hypercalcaemia in cancer

A

shift calcium out of the intravascular space

51
Q

RF associated with TLS

A
  • rapidly dividing cells
  • bulk of disease is high
  • good response to tx
  • pre-exsiting renal impairment or dehydration
  • High serum LDH
  • high WCC
52
Q

which chemotherapy agents are associated with hand-foot syndrome?

A

5FU, docetaxel

53
Q

RF for developing prostate cancers

A

Age >50-65
Ethnicity: black >white, black: early and aggressive
FHx
BRCA1/BRCA2: more aggressive form
Smoking

RACP (20 decks)

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