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4MB Medicine > Oncology > Flashcards

Oncology Flashcards

1
Q

List the main oncological emergencies

A

Spinal cord compression
Superior vena cava obstruction
Raised ICP
Hypercalcaemia

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2
Q

What are some causes of spinal cord compression?

A

Extra-cordal compression (tumour)
Vertebral body extension (osteophyte)
Osteoporotic crush fracture

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3
Q

List symptoms and signs of spinal cord compression

A 
Back pain
Radicular (band-like) pain
Pain worse on cough/straining
Bowel/urinary change
Weakness
Altered sensation
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4
Q

What investigations would you order for spinal cord compression?

A

Urgent MRI

Lumbar puncture if suspected meningeal involvement

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5
Q

How is spinal cord compression treated?

A

Acute: IV dexamethasone
Surgery
Radio/chemo therapy

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6
Q

List some causes of superior vena cava obstruction

A

Intrinsic: clot, foreign body, tumour
Extrinsic: mass/tumour, aneurysm, fibrosis
Thrombosis, ovarian hyper-stimulation

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7
Q

List symptoms and signs of superior vena cava obstruction

A 
Dyspnoea
Swollen face/neck/arms
Distended veins
Headache
Organomegaly
Non-collapsing veins
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8
Q

What is Pemberton’s test for superior vena cava obstruction?

A

Lift arms over head

If causes facial plethora/cyanosis and raised JVP, obstruction is likely

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9
Q

How is superior vena cava obstruction?

A

Clot - streptokinase, anticoagulation
Oral dexamethasone
Chemo/radio therapy
Stenting

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10
Q

List causes of hypercalcaemia in oncological patients

A

Lytic bone mets
Myeloma
PTH-producing tumour

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11
Q

List symptoms and signs of hypercalcaemia

A 
Lethargy
Anorexia
Nausea
Polydipsia
Polyuria
Constipation
Confusion
Weakness
Moans, groans, aches and stones
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12
Q

How is hypercalcaemia treated?

A

Manage underlying malignancy
Bisphosphonates
Calcitonin

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13
Q

List symptoms and signs of raised ICP

A 
Headache, worse in morning or straining
Nausea
Vomiting
Papilloedema
Fits
Focal neurological deficit
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14
Q

What investigations would you order for raised ICP?

A

Urgent CT/MRI head

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15
Q

How is raised ICP treated?

A

Dexamethasone PO
Radiotherapy
Surgery
Mannitol may give symptomatic relief

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16
Q

What is meant by neoadjuvant chemotherapy?

A

Shrink tumour prior to surgery

Early control of metastasis

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17
Q

What is meant by primary chemotherapy?

A

Sole treatment for malignancy

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18
Q

What is meant by adjuvant chemotherapy?

A

Given post- surgery/radiotherapy to decrease risk of remission

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19
Q

What is meant by palliative chemotherapy?

A

Given for symptomatic relief and prolong survival, i.e. non-curative intent

20
Q

What do antimetabolic chemotherapy agents do? Name some?

A

Inhibit processes that promote growth/synthesis

Methotrexate, 5-fluoroucil, azathioprine

21
Q

What do anti-tumour antibody chemotherapy agents do? Name some?

A

Inhibit DNA transcription and replication via topiromase inhibitors
Doxorubicin, etoposide, actinomycin

22
Q

What do antimicrotubule chemotherapy agents do? Name some?

A

Prevent separation of chromatids during replication

Vincristine, vinblastine, paclitaxel

23
Q

What do alkylating chemotherapy agents do? Name some?

A

Alkylate functional groups to form covalent bonds

Cyclophosphamide, chlorambucil, cisplatin, busulfan

24
Q

What do monoclonal antibody chemotherapy agents do? Name some?

A

Target tumour-specific antigens

Rituximab (CD20), cefuximab (EGFR1), bevacizumab (VEGF), imatinib (TK1)

25
Q

List some side effects of chemotherapy

A 
Vomiting
Alopecia
Neutropenia
Infertility
Rash
26
Q

How does radiotherapy work?

A

Uses ionising radiation to produce free radicals that damage DNA

27
Q

Why is radiotherapy delivered in fractions?

A

Gives normal cells time to recover

28
Q

What is the difference between radical and palliative radiotherapy in terms of the doseage given?

A

Radical - 40-70Gy in 15-35 fractions

Palliative - 8-30Gy in 1-10 fractions

29
Q

List some early side effects of radiotherapy

A 
Tiredness
Skin reactions
Mucositis, oral thrush
Nausea, vomiting
Diarrhoea
Dysphagia
30
Q

List some late side effects radiotherapy

A

CNS: somnolence, weakness, reduced IQ, plexopathy
Lung: pneumonitis, cough, dyspnoea
GI: dry mouth, strictures, inflammation
GU: frequency, infertility, dyspareunia, vaginal stenosis
Erectile dysunction, endocrine disturbance

31
Q

List palliative drugs used for nausea and vomiting

A 
Cyclizine (anti-histamine)
Domperidone (blocks CTZ)
Metoclopramide (anti-dopaminergic, pro-kinetic)
Haloperidol (dopamine antagonist)
Odansetron (5-HT antagonist)
32
Q

List palliative drugs used for constipation

A

Bisacodyl

Movicol

33
Q

List palliative drugs used for breathlessness

A

Oxygen
Morphine (reduces resp drive)
BZD’s
Pleurodesis, thoracocentesis

34
Q

List palliative drugs used for dry mouth

A

Chew ice or pineapple
Oral hygiene
Pilocarpine

35
Q

List palliative drugs used for itch

A

Cholesyramine

Ursodeoxycholic acid

36
Q

List palliative drugs used for agitation/hallucinations

A

Haloperidol
Quetiapine
Midazolam

37
Q

List palliative drugs used for excessive secretions

A

Buscopan (hyoscine hydrobromide)

38
Q

List palliative drugs used for pain

A

Non-opioid (paracetamol, aspirin, NSAID)
+ weak opioid (codeine, dihydrocodeine, tramadol)
+ strong opioid (morphine, diamorphone, oxycodone, fentanyl)

39
Q

What tumours cause raised AFP?

A

Hepatocellular carcinoma
Germ cell tumour
Also hepatitis, cirrhosis, pregnancy

40
Q

What tumours cause raised CA 125?

A

Ovarian cancer
Uterine cancer
Breast cancer
Hepatocellular carcinoma

41
Q

What tumours cause raised CA 153?

A

Breast cancer

42
Q

What tumours cause raised CA 199?

A

Colorectal cancer
Pancreatic cancer
Cholestasis

43
Q

What tumours cause raised CA 2729?

A

Breast cancer

44
Q

What tumours cause raised CEA?

A 
GI cancer (esp colorectal)
Also cirrhosis, pancreatitis, smoking
45
Q

What tumours cause raised HER2?

A

Breast cancer
Ovarian cancer
Stomach cancer
Uterine cancer

46
Q

What tumours cause raised B-HCG?

A

Germ cell cancer
Hydatiform mole
Choriocarcinoma
Also pregnancy

47
Q

What tumours cause raised PSA?

A

Benign nodular hyperplasia of prostate

Prostate adenocarcinoma

4MB Medicine (19 decks)

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