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FRACP 2023 Cram Homicrons Edition > Oncology > Flashcards

Oncology Flashcards

1
Q

Histopath findings: Reed Sternberg Cells

A

Hodgkin Lymphoma

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2
Q

Philadelphia Chromosome- BCR-ABL fusion (9:22)

A

B-Cell ALL- POOR prognostic sign
- Poor response to chemo is the worst prognostic sign

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3
Q

Mutation- PTPN11 (associated with Noonan’s)- can be somatic or germline

A

JMML

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4
Q

GATA1 mutations/ ALL or AML

A

Down’s Syndrome/T21

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5
Q

Histopath findings: Starry sky appearance on film

A

Burkitt Lymphoma

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6
Q

Histopath findings: Auer rod

A

AML

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7
Q

Signs of VOD?

A

Jaundice and hyperbilirubinaemia
Right upper quadrant pain, generally with tender hepatomegaly.- raised transaminases
Weight gain and ascites

DDx: portal obstruction- expect splenomegaly

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8
Q

DDx anterior, posterior, superior & middle mediastinal masses

A

Posterior: Neuroblastoma (adjacent to paraspinal ganglion), thoracic meningiocele, aortic aneurysm

Superior: cystic hygroma, thymic mass, teratoma, ectopic thyroid, oesophageal lesions, AVM

Anterior: epithelial tumor, lymphoma, thymoma

Middle: lymphoma, lymphadenopathy, bronchogenic/pericardial cysts

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8
Q

Blood findings in TLS & management

A

High K
High Phos
High uric acid
Low calcium

  1. Hyperhydration/HCO3
  2. Rasburicase= promotes the conversion of uric acid to allantoin, which is less harmful and easily excreted
  3. Allopurinol = xanthine oxidase inhibitor, TLS prophylaxis
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9
Q

What patients need irradiated blood cells?

A

Patients at risk of GVHD:
* Transplant.
* Hodgkin lymphoma, aplastic anaemia.
* Monoclonal antibodies or therapeutic antibodies.
* Granulocyte transfusions.

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10
Q

Denys-Drash & Frasier syndrome and tumor associated?

A

Wilms (WT1)

  • Early-onset renal failure
  • XY gonadal dysgenesis

Frasier

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11
Q

M phase chemo drugs?

A

Vincristine/blastine
Docetaxel/paclitaxel

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12
Q

S phase chemo drugs?

A

Antimetabolites:
- Folate analoges: methotrexate
- Purine analogues: fludarabine, mercaptopurine, thioguanine
- Pyrimidine analogues: cytarabine, 5-FU

Misc: hydroxyurea

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13
Q

G2 phase chemo drugs?

A

Topoisomerase 1 inhibitors: etopaside
Bleomycin

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14
Q

G1 phase chemo drugs?

A

Asparaginase/PEG

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15
Q

Common pathogens in febrile neutropenia
(patients with Rx AML, cytarabine, awaiting transplant)

A

Strep mitis (CONS- occupies port/line)

16
Q

Chemotherapies at risk of 2nd malignancy

TAAAT

A

Topoisomerase inhibitors

Alkylating agents (cyclophosphamide)- biggest risk

Anthracyclines (doxorubicin)

Antimetabolites (MTx, thiopurine, mycophenylate)

(anti)Tubulin (vincristine)

17
Q

Cancer with highest likelihood of secondary malignancy

A

Hodgkin lymphoma- 18.5x increase

  • AML (3yrs)
  • Breast
  • Thyroid
  • Soft tissue
    (14yrs solid)
18
Q

Mutation and Ca predisposition in T21?

A

AML in Trisomy 21
* Secondary to GATA1 mutation
* 150x increased risk of AML
* Increased sensitivity to chemotherapy, survival >90% age <4years

19
Q

Favourable prognosis genes in AML

A

RUNX
CBFb-MYH
NPM
CEBPA

20
Q

Poor prognosis gene mutations in AML

A

Monosomy 5,7
FLT/ITD
KMT2A
NUP
DEK

21
Q

Dx on this Xray?

A

Ewings sarcoma

22
Q

Dx on this XR?

A

Osteosarcoma
5-25yrs, M>F
- Most common bone tumor
- Most commonly long bone metaphyses (distal femur/prox humerus, tibia, pelvis and skull)
- Formed by osteoblasts/mesenchymal cells

XR: dense sclerosis at metaphysis with soft tissue expansion- ‘sunburst appearence’

23
Q

Explain 2 hit hypothesis with retinoblastoma

A
  1. Germline mutation of one of the RB1 tumour suppressor gene
  2. Second mutation in the remaining RB1 allele of retinal cells.
24
Q

Most important factors impacting survival for donor cell transplant in 8/8 HLA matched unrelated donor?

A
  1. full HLA match of the donor at HLA-A, HLA-B, HLA-C and HLA-DR loci- overall survival drops 10% with each mismatch
  2. Age 5.5% increase in risk for each 10yr increment
  3. CMV- seronegative = better survival
  4. ABO compatability not required however can lead to complications if incompatible
25
Q

Which is more common AML/ALL? Features to suggest

A

ALL 75%

AML 20%
- Gum hypertrophy
- Syndromic association

Both have HSM, pancytopenia with blasts

26
Q

Cell markers AML vs ALL

A

AML
- CD7, 3
- MPO

ALL
- CD34, CD 19, CD10, CD 79a, CD33

FRACP 2023 Cram Homicrons Edition (29 decks)

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