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Clinical Years / Progress Test > Oncology > Flashcards

Oncology Flashcards

1
Q

what is performance status

A

describes a patients fitness in relation to how well they will cope with treatment
0-5
0 fully active
5 deceased

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2
Q

Pancreatic cancer tumour marker

A

CA 19-9

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3
Q

Ovarian cancer tumour marker

A

Ca125

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4
Q

Breast cancer tumour marker

A

Ca15-3
Note tumour markers have low specificity

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5
Q

Features of bony metastases

A

Bone pain
Raised ALP
Hypercalcaemia
Pathological fractures

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6
Q

Management and of chemotherapy nausea and vomiting

A

Low risk; metaclopramide first line

High risk; 5-HT3 antagonists such as ondansetron

Higher risk, opioids, anxiety, over 50, type of chemotherapy

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7
Q

Signs of spinal cord compression

A
  • back pain
  • lower limb weakness
  • sensory changes
  • neurological signs; depending where compression occurs. If below L1 LMN signs (cauda equina) if above UMN signs
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8
Q

Investigation and management of spinal cord compression

A

Full spine MRI urgently

High dose oral dexamethasone

Urgent oncological review for radiotherapy or surgery

flat bed rest + analgesia

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9
Q

Spinal metastases presentation

A

Can precede spinal cord compression so important to detect

Unrelenting lumbar back pain
Any thoracic or cervical back pain
Nocturnal pain
Worse with sneezing/coughing
Associated tenderness

Needs MRI within a week if no neurological features

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10
Q

What is superior vena cava obstruction?
What cancer most associated with?
Other causes?

A

Oncological emergency caused by compression of the superior vena cava

Most commonly caused by lung cancer
Other causes;
- lymphoma, breast Ca and other malignancies
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis

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11
Q

Features of superior vena cava obstruction

A

Dyspnoea - most common symptom
Swelling of face, neck and arms
Headache
Visual disturbance
Pulseless jugular venous distention

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12
Q

Management superior vena cava obstruction

A

A-E approach

  • endovascular stent for symptom relief
  • certain malignancies may benefit from chemo or chemo-radiotherapy
  • glucocorticoids are often given (dex)

ask oncology team; depends on individual patient and malignancy

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13
Q

lung cancer presentation at GP pathway

A

urgent CXR if 2 of following age40+ or one + a smoker
- cough
- fatigue
- SoB
- chest pain
- weight loss
- appetite loss

if CXR suggests malignancy or is unclear then 2ww to specialist

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14
Q

what information do radiology need before doing a CT

A

previous contrast reaction?
renal function
diabetes - if on metformin may need to be stopped for scan

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15
Q

important tests at any 2ww specialist appointment

A

PMHx - fitness for surgery/chemo/radio

FBC
renal function
liver function
bone profile

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16
Q

lung cancer specific investigations

A

pulmonary function tests
bronchoscopy and biopsy
CT staging scan (mot cancers need)

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17
Q

main oncological emergencies

A

neutropenic sepsis

SVCO

hypercalcaemia

spinal cord compression

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18
Q

management neutropenic sepsis

A

A-E
plus
sepsis six; Abx, oxygen, fluids in, blood cultures, urine output, lactate out

investigate for cause
involve seniors

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19
Q

when does neutropenia most occur after chemotherapy

A

around 5-12 days after treatment

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20
Q

treatment of hypercalcaemia

A

IV fluid rehydration - monitor balance and electrolytes

bisphosphonate after rehydration

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20
Q

small cell lung cancer features

A

typically centrally located
rapidly growing
often smoking related
chemo/radiosensitive but rarely cured
short prognosis

21
Q

squamous cell lung cancer features

A

typically centrally located - early symptoms
smoking related
best survival rate

22
Q

adenocarcinoma of lung features

A

typically peripherally located
slowest growing
can be non-smokers
can respond well to systemic agents

may metastasise early due to location

23
Q

TNM staging lung cancer

A

T1 <3cm
T2 3-5cm
T3 5-7cm
T4 >7cm

N0-N3 (n2 and 3 mediastinal nodes, ipsi and contra)

M0
M1a, b and c
a extra nodule
b intra thoracic mets
c extra thoracic mets

24
Q

brain mets presentation and investigation

A

headahces
confusion

MRI brain
imaging of primary
routine bloods - exclude hypercalcaemia, infections etc

25
Q

immediate management of brain mets

A

dexamethasone
(may add PPI too)

26
Q

denosumab
- action
- indications
- important side effects

A

RANK ligand inhibitor - works on bone remodelling

prevention of skeletal related events in bone mets from advanced breast cancer or other solid tumours except prostate
also licensed for osteoporosis

high dose every 4 weeks in cancer

important side effects; hypocalcaemia, osteonecrosis of the jaw

27
Q

blood tests metastatic presentation

A

FBC
U+Es
LFTs
bone profile

28
Q

how are skeletal metastasis assessed

A

isotope bone scan

29
Q

treatments available for metastatic breast cancer

A

depending on status of cancer but

  • endocrine therapy
  • chemotherapy
  • Herceptin therapy
  • bisphosphonate/denosumab
30
Q

CDK4/6 inhibitors

A

increasingly used in breast cancer

predominantly used alongside endocrine drugs in ER-positive HER2-negative cancers

CDk4/6 are proteins that control cell growth and division

31
Q

main important reaction to immunotherapy drugs

A

allergic reaction

32
Q

how do most immunotherapy drugs act

A

as checkpoint inhibitors

33
Q

side effects of immunotherapy

management

A

immune related organ side effects; colon, lungs, liver, endocrine
fatigue and skin changes also common

typically occur weeks to months after treatment starts

severe or persistent side effects can be managed with steroids and treatment may be stopped

34
Q

investigation of a suspicious lymph node

A

USS and biopsy

35
Q

how can immunotherapies cause toxicity

A

immune-mediated toxicities due to activation of the immune system to target cancer cells
treated with corticosteroids to immunosuppressive

36
Q

immunotherapy and PMHx of autoimmune conditions

A

can worsen existing autoimmune conditions by activating the immune system

37
Q

grading of immunotherapy reactions

A

toxicity reactions/side effects are graded 1-5
1 no or mild symptoms
5 death

38
Q

management of immunotherapy related diarrhoea

A

caused by an inflammatory colitis which can progress
needs investigation with a sigmoidoscopy and needs high dose immunosuppression

39
Q

BRAF inhibitors in melanoma

A

about 50% of melanomas are positive for BRAF V600 mutation (oncogene) so an option for treatment in BRAF inhibitors

40
Q

what does the HPV vaccine cover?

A

protects against HPV 16 and 18 which are responsible of approximately 70% of cases of cervical cancer, and types 6 and 11 which are associated with genital warts

41
Q

who is offered the HPV vaccine

A

girls and boys aged 12-13 in school
catch up is available for anyone up to the age of 25

Men who have sex with men, trans women and trans men are eligible for catch up up until aged 45

42
Q

when does cervical screening commence

A

people with a cervix are screened from age 25
up to age 49 get invitations every 3 years
aged 50-64 every 5 years presuming HPV is negative

43
Q

what happens if cervical smear sample is HPV positive

A

cytology is carried out on the sample to triage for colposcopy. If cytology is negative then screening will be repeated in 1 year

if changes seen on cytology then invited for colposcopy

44
Q

pelvic radiotherapy and fertility

A

likely to result in infertility
consider preservation techniques

can also cause sexual function problems

45
Q

how may radiotherapy be delivered to the cervix

A

brachytherapy - a radioactive source inserted into the vagina/cervix
delivers local radiotherapy

46
Q

how is chemotherapy typically dosed

A

according to body surface area

47
Q

What type of lymph node biopsy in suspected lymphoma

A

Excisional lymph node biopsy

48
Q

What information does a patient need to be aware of when discussing a clinical trial

A
  • what the trial is + details of the treatment and follow up
  • that they can withdraw at any time
  • entry is voluntary and refusal will not affect their care
  • the standard therapy that is available if they choose not to enter
49
Q

How is neutropenic sepsis defined

A

Temperature >38 and neutrophil count of <0.5x10^9 per litre

50
Q

what type of cancer can AFP be raised in

A

hepatocellular carcinoma

Clinical Years / Progress Test (24 decks)

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