Oncology

Question 1

What is the most common tumour causing bone mets?

Answer 1

Most common tumour causing bone metastases (in descending order)
-prostate
-breast
-lung

Question 2

What is the most common sites of bone mets?

Answer 2

Most common site (in descending order)
-spine
-pelvis
-ribs
-skull
-long bones

Question 3

Give 3 complications of boney mets?

Answer 3

Other than bone pain, features may include:
pathological fractures
hypercalcaemia
raised ALP

Question 4

What are the most common causes of cancer in the UK?

Answer 4

he most common causes of cancer in the UK are as follows*
1. Breast
2. Lung
3. Colorectal
4. Prostate
5. Bladder
6. Non-Hodgkin’s lymphoma
7. Melanoma
8. Stomach
9. Oesophagus
10. Pancreas

Question 5

What are the most common causes of cancer deaths in the UK?

Answer 5

The most common causes of death from cancer in the UK are as follows:
1. Lung
2. Colorectal
3. Breast
4. Prostate
5. Pancreas
6. Oesophagus
7. Stomach
8. Bladder
9. Non-Hodgkin’s lymphoma
10. Ovarian

Question 6

What are the risk factors for the development of nausea and vomiting in chemo? 4

Answer 6

Nausea and vomiting are common side-effects of chemotherapy. Risk factors for the development of symptoms include:
anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used

Question 7

What may be used for nausea and vomiting in chemo?

Answer 7

For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line. For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone

Question 8

What is cyclophosphamide? how does it work?

Answer 8

Cyclophosphamide is an alkylating agent used in the management of cancer and autoimmune conditions. It works by causing cross-linking of DNA

Question 9

What are 3 adverse effects of cyclophosphamide?

Answer 9

Adverse effects
-haemorrhagic cystitis: incidence reduced by the use of hydration and mesna
-myelosuppression
-transitional cell carcinoma

Question 10

What is Mesna?

Answer 10

Mesna
2-mercaptoethane sulfonate Na
a metabolite of cyclophosphamide called acrolein is toxic to urothelium
mesna binds to and inactivates acrolein helping to prevent haemorrhagic cystitis

Question 11

Cyclophosphamide
-How does this work?
-What are the complications?

Answer 11

Cyclophosphamide
-Alkylating agent - causes cross-linking in DNA
-Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

Question 12

Bleomycin
-How does this work?
-What are the complications?

Answer 12

Degrades preformed DNA
Lung fibrosis

Question 13

Anthracyclines (doxorubicin)
-How does this work?
-What are the complications?

Answer 13

Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis
Cardiomyopathy

Question 14

Methotrexate
-How does this work?
-What are the complications?

Answer 14

Inhibits dihydrofolate reductase and thymidylate synthesis Myelosuppression, mucositis, liver fibrosis, lung fibrosis

Question 15

Fluorouracil (5-FU)
-How does this work?
-What are the complications?

Answer 15

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

Question 16

6-mercaptopurine
-How does this work?
-What are the complications?

Answer 16

Purine analogue that is activated by HGPRTase, decreasing purine synthesis
Myelosuppression

Question 17

Cytarabine
-How does this work?
-What are the complications?

Answer 17

Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase Myelosuppression, ataxia

Question 18

Vincristine, vinblastine
-How do these work?
-What are the complications?

Answer 18

Inhibits formation of microtubules

Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression

Question 19

Docetaxel
-How does this work?
-What are the complications?

Answer 19

Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
Neutropaenia

Question 20

Ironotecan
-How does this work?
-What are the complications?

Answer 20

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA Myelosuppression

Question 21

Cisplatin
-How does this work?
-What are the complications?

Answer 21

Causes cross-linking in DNA
Ototoxicity, peripheral neuropathy, hypomagnesaemia

Question 22

Hydroxyurea (hydroxycarbamide)
-How does this work?\
-What are the complications?

Answer 22

Inhibits ribonucleotide reductase, decreasing DNA synthesis Myelosuppression

Question 23

Tumour markers -
CA 125
CA 19-9
CA 15-3

Answer 23

CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer

Question 24

Tumour markers -
Prostate specific antigen (PSA)
Alpha-feto protein (AFP)
Carcinoembryonic antigen (CEA)
S-100
Bombesin

Answer 24

Prostate specific antigen (PSA) Prostatic carcinoma
Alpha-feto protein (AFP) Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA) Colorectal cancer
S-100 Melanoma, schwannomas
Bombesin Small cell lung carcinoma, gastric cancer, neuroblastoma

Question 25

What are the 3 most common types of cancer in females?

Answer 25

The 3 most common types of cancer in females are:

1. Breast
2. Lung
3. Bowel

Question 26

What cancer:
\Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level

Answer 26

Non-seminomatous testicular cancer

A raised alpha-feto protein level excludes a seminoma