Oncology

Question 1

What is Filgrastim and what is it used for?

Answer 1

Used in the treatment for Neutropenic sepsis.
Is a Recombinant granulocyte-colony stimulating factor (G-CSF) and works by stimulating the bone marrow

Question 2

What is Marjolin’s ulcer?

Answer 2

A rare disease that involves the development of an SCC within the site of a scar or an ulcer.

Question 3

What increases risk of Ovarian Cancer?

Answer 3

• The higher the number of ovulation cycles in a woman’s lifetime, the higher the risk of ovarian cancer
• COCP use
• Multiparity
• Breastfeeding

Question 4

What are risk factors for breast cancer?

Answer 4

Uninterrupted oestrogen exposure
- Early menarche, late menopause or nulliparity
- First pregnancy after age 35
- Not breastfeeding
- Obesity
- COCP use
- HRT use

Question 5

What tumour marker can be used to assess response to treatment in Breast cancer?

Answer 5

Ca 15-3

Question 6

What can raise your PSA levels?

Answer 6

• UTI
• Prostate biopsy
• DRE
• Urinary catheterisation
• Ejaculation within the last 48 hours
• Anal sexual intercourse
• Vigorous exercise

Question 7

When are symptoms of SVC obstruction worse?

Answer 7

Worse on bending over, lying flat or lifting the arms above the head

Question 8

What is the investigation of choice for metastatic cord compression?

Answer 8

MRI whole spine

Question 9

What is tumour lysis syndrome?

Answer 9

Severe metabolic disturbance caused by the sudden release of large quantities of cellular components into the blood following the rapid lysis of malignant cells.

Question 10

Which patients are at high risk of neutropenic sepsis?

Answer 10

• Have sustained, significant neutropenia that is expected to last more than 7 days
• Are clinically unstable
• Have an underlying malignancy and are being treated with high-intensity chemotherapy
• Have significant comorbidities

Question 11

What are the main aetiological factors for head and neck cancers?

Answer 11

• Tobacco use
• Alcohol consumption
• HPV
• EBV

Question 12

What are the biochemical findings in tumour lysis syndrome?

Answer 12

Hyperuricaemia, hyperphosphataemia, Hyperkalaemia and hypocalcaemia

Question 13

What are some signs and symptoms of tumour lysis syndrome?

Answer 13

Related to electrolyte abnormalities:
- Dysuria or oliguria
- Weakness
- Nausea or vomiting
- Muscle cramps
- Seizures
- Cardiac Arrhythmias
- Gout/joint swelling

Question 14

What is the management of tumour lysis syndrome?

Answer 14

• Correction of electrolyte imbalances: This may require dialysis in severe cases
• IV fluids
• Medications: Allopurinol or rasburicase may be given to prevent or treat hyperuricaemia

Question 15

What are some strong risk factors for Bowel cancer?

Answer 15

• Increasing age
• Hereditary syndromes
• Increased alcohol intake
• Smoking tobacco
• Processed meat
• Obesity
• Previous exposure to radiation
• IBD

Question 16

What is the current screening programme for bowel cancer?

Answer 16

• FIT every 2 years for men and women age 60-74. If positive patients are referred for colonoscopy

Question 17

What initial blood tests could you do for bowel malignancy?

Answer 17

FBC, Iron studies and Carcinoembryonic antigen (CEA)

Question 18

What is the likelihood of developing colorectal cancer in familial adenomatous polyposis?

Answer 18

Virtually guaranteed by 20s unless they undergo prophylactic proctocolectomy

Question 19

What is HNPCC caused by?

Answer 19

Is caused by a mutation in the mismatch repair genes MLH1/MSH2 and has an autosomal dominant inheritance pattern.

Question 20

What is Peutz-Jeghers syndrome?

Answer 20

Is caused by a mutation in the STK11 gene and has an autosomal dominant inheritance pattern.

Patients typically present in their teens with mucocutaneous pigmentaiton and hamartomatous polyps.

Question 21

What is the first-line opioid of choice in patients with stage 4 or 5 chronic kidney disease?

Answer 21

Alfentanil

Question 22

What is Li Fraumeni Syndrome?

Answer 22

A rare autosomal dominant disorder. It is the result of germ line mutation of the p53 tumour suppressor gene. It leads to an increased risk of sarcoma and cancer of the breast, brain and adrenal glands.

Question 23

What test can help to diagnose medullary thyroid cancer?

Answer 23

Calcitonin

Question 24

How do you characterise neutropaenic sepsis?

Answer 24

Temperature >38.5 °C, or two consecutive readings >38 °C, in a patient with a neutrophil count of <0.5 × 109/l (or expected to fall below this level in the next 48 hours).

Question 25

What is the most common type of ovarian cancer?

Answer 25

• Epithelial ovarian cancer

Question 26

What are some late side effects of radiotherapy?

Answer 26

• Skin pigmentation changes
• Pulmonary fibrosis
• Infertility
• Secondary cancers
• Constrictive pericarditis
• Dysphagia

Question 27

How does Spinal cord compression present?

Answer 27

• UMN Signs: Hyperreflexia, spasticity, and a positive Babinski’s signs
• Sesnory disturbance: Typically below the level of the lesion
• Deep and localised back pain
• Radicular senory disturbance: A stabbing sesnation at the level of the lesion
• Bladder and bowel involvement

Question 28

What cancers commonly cause superior vena cava obstruction?

Answer 28

Non-small cell lung cancer, small cell lung cancer and lymphoma

Question 29

What is a positive Pemberton’s test and what does it indicated?

Answer 29

Involves lifting the arms over the head for more than 1 minute; this will precipitate facial plethora and cyanosis.

Indicates Superior vena cava obstruction

Question 30

How do you diagnose SVCO?

Answer 30

CT scan of the thorax

Question 31

What is the management of SVCO?

Answer 31

• Oral dexamethasone 8mg BD

Question 32

What is the most common route of metastasis?

Answer 32

Haematogenous spread