Oncology Flashcards
What cancers have screening programmes ?
Breast
Cervix
Bowel
What are the 6systemic red flags symptoms of cancer ?
- Unexplained weight loss
- Loss of appetite
- Fatigue
- Back pain
- Night sweats
- Unexplained anaemia
what is the WHO performance status ?
- 0 = fully active
- 1 = Restricted in physical strenuous activity but ambulatory and able to carry out light work.
- 2 = Ambulatory and capable of all self care. No work activities. Awake for >50% of waking hours.
- 3 = Confined to bed / chair >50% of working hours
- 4 = bed bound.
What are the 4 types of treatment in regards to non surgical oncology
- Curative / radical = aims to cure
- Neoadjuvant = therapy before surgery / radiotherapy with aim to shrink cancer
- Adjuvant = aims to reduce risk of local or distant recurrence by treating metastatic disease. After surgery.
- Palliative = not curative but aimed at improving quality of life and survival
What is neutropenic sepsis ?
- Complication of cancer therapy, usually occurring 7-14 days after treatment
How is neutropenic sepsis defined ?
- Neutrophil count of <1*10^9 + either :
- Temp of higher than 38
- Other signs / symptoms consistent with clinically significant sepsis
what is the most common cause of neutropenic sepsis ?
- Staphylococcus epidermidis
What can be given as prophylaxis to neutropenic sepsis ?
- Fluoroquinolone
- Antifungals
- Granulocyte colony-stimulating factor (G-CSF)
How is neutropenic sepsis managed ?
- Immediate empirical therapy ( IVTazocin = piperacillin + tazobactam)
- DO NOT wait for FBC, aim to give within an hr of presentation.
What 5 cancers most commonly spread to bone ?
- Prostate
- Breast
- Lung
- Kidney
- Thyroid
BLT ketchup please
How is malignancy spinal cord compression managed ?
- Same day whole spine MRI.
- High dose steroids = dexamethasone 8mg BD with PPI and monitor BMs)
- Urgent discussion with oncology and spinal surgeons.
- Surgical decompression / stabilisation vs radiotherapy
How can malignant spinal cord compression present ?
- WORSENING back pain -> worse on lying / coughing
- Lower limb weakness
- Sensory loss / changes
- Bowel or bladder dysfunction
- Radicular pain
- Abnormal neurological examination
Where are the neurological signs seen dependent on the level of spinal cord compression ?
- Lesion above L1 = UMN signs in legs and a sensory level
- Lesion below L1 = LMN signs in the legs and perianal numbness.
Other than bone pain, what features are seen in bone metastases ?
- Pathological fractures
- Hypercalcaemia
- Raised ALP
What can cause malignant hypercalcaemia ?
- Bone metastases = osteolysis
- Humoral = PTHrP in squamous cell lung cancer
- Dehydration
How does hypercalcaemia present ?
- Kidney stones
- Bone pain
- GI : abdo pain, vomiting, constipation
- Psych : depression
How is malignant hypercalcaemia managed ?
- Correct dehydration : 0.9% saline 3-4L
- Following rehydration : IV bisphosphonates (Zolendronic acid)
Why are IV bisphosphonates used in hypercalcaemia and what are their SE ?
- They inhibit osteoclasts.
- Se : flu like symptoms, bone pain, myalgia, reduced phosphate levels, N&V, headache
what cancer most commonly causes SVC obstruction
- Lung cancer
- Lymphoma
6 Features of SVC obstruction
- Dyspnoea = most common symptom
- Swelling of the face, neck and arms
- Conjunctival and periorbital oedema
- Headache: often worse in the mornings
- Visual disturbance
- Pulseless jugular venous distension
How is SVC obstruction diagnosed ?
- CXR + widened mediastinum
- CT scan
How is SVC obstruction managed ?
- Elevation of head and O2 for symptomatic relief
- High dose steroids
- Endovascular stenting
- Further radio/chemotherapy depends on the type of cancer
what carcinogens are associated with what cancers ?
- Aflatoxin = hepatocellular carcinoma
- Aniline dyes = bladder (transitional cell carcinoma)
- Asbestos = mesothelioma and bronchial carcinoma
- Nitrosamines = oesophageal and gastric
- Vinyl chloride = hepatic angiosarcoma
Common SE of chemotherapy
- N&V
- Fatigue
- Sepsis
- Myelosuppression
- Impact on renal liver function
- Alopecia
- Blood clots
- Infertility
- Allergic reactions
what kind of chemotherapy is cyclophosphamide ?
- Alkylating agent = causes cross-linking of DNA
Give 3 adverse effects of cyclophosphamide
-> Haemorrhagic cystitis (mesna used to prevent)
-> Myelosupression
-> Transitional cell; carcinoma
CA 125
- CA 125 = ovarian
What tumour antigens are associated with what cancers ?
- PSA = prostatic carcinoma
- AFT = hepatocellular carcinoma, teratoma
- Carcinoembryonic (CEA) = colorectal
- S-100 = melanoma, schwannomas
- Bombesin = SCLC, gastric and neuroblastoma
Give an example of an anthracycline cytotoxic agent, how it works and an adverse effect
- Doxorubicin
- Inhibits DNA & RNA synthesis
- Cardiomyopathy
Give an example of an antimetabolite cytotoxic agent and its advertse effcets
- Methotrexate
- Myelosuppression, mucositis, liver fibrosis and lung fibrosis
How does Docetaxel work and what is an adverse effect ?
- Prevents microtubule depolymerisation
- Neutropenia
Tumour markers for recurrence of testicular teratoma
Alpha-fetoprotein
Beta-HCG
Tumour marker for breast cancers
CA 15-3
Tumour marker for pancreatic cancer
CA 19-9
Tumour marker for hepatocellular carcinoma
Alpha-fetoprotein
what does a PET scan demonstrate
Glucose uptake
what is the BRCA2 mutation associated with in men
Prostate cancer
Medication to help with N&V caused by intracranial masses
Dexamethasone
Action of cyclophophamide and 3 adverse effects
- Alkylating agent
- Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
Adverse effect of bleomycin
Lung fibrosis
Adverse effect of anthracyclines (e.g. doxorubicin)
Cardiomyopathy
4 SE of methotrexate
Myelosuppression
Mucositis
Liver fibrosis
Lung fibrosis
3 SE of fluorouracil
Myelosupression
Mucositis
Dermatitis
most common lung cancer in non smockers
Adenocarcinoma
Lung cancer most strongly associated with smoking
squamous cell cancer
SE of 6-mercaptopurine
Myelosuppresion
2 SE of cytarabine
Myelosuprresion, ataxia
2 Adverse effect of vincristine
Peripheral neuropathy
Paralytic ileus
se of docetaxel
Neutropenia
3 SE of Cisplatin
Hypomagnesaemia
Ototoxicity
Peripheral neuropathy
SE of hydroxycarbamide
Myelosupression
CA 19-9
pancreatic cancer
CA 15-3
breast cancer
Alpha-feto protein
Hepatocellular carcinoma
Teratome
Carcinoembryonic antigen
Colorectal cancer
S-100
Melanoma
Schwannomas
Bombesin
SSLC
Gastric cancer
Neuroblastoma
Calcitonin
Medullary thyroid cancer
HPV strains associated with cervical cancer
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