Oncology

Question 1

most common cancers causing bone metastases

Answer 1

prostate
breast
lung

Question 2

most common site of bone metastases

Answer 2

spine
pelvis
ribs
skull
long bones

Question 3

pathogenesis of HPV in cervical cancer

Answer 3

Subtypes 16,18 & 33 are particularly carcinogenic

infected endocervical cells undergo changes into koilocytes - enlarged and darker nucleus, irregular nuclear membrane,

Question 4

management of chemotherapy side effects

Answer 4

low risk of sx - metoclopramide

high risk sx - 5HT3 receptor antagonists e.g., ondansetron

Question 5

examples of alkylating agents

Answer 5

cyclophosphamide

causes crosslinking in DNA

S/E - haemorrhagic cystitis, myelosuppression, TCC

Question 6

examples of cytotoxic antibiotics

Answer 6

bleomycin - degrades preformed DNA - S/E lung fibrosis

anthracyclines (e.g., doxorubicin) - stabilises DNA-topoisomerase II complex and inhibits DNA/RNA synthesis - S/E cardiomyopathy

Question 7

examples of antimetabolites

Answer 7

methotrexate - inhibits dihydrofolate reductase - may cause myelosuppression, mucositis, liver fibrosis, lung fibrosis

fluorouracil - pyrimidine analogue inducing cell cycle arrest and apoptosis - myelosuppression, mucositis, dermatitis

6-mercaptopurine - purine analogue that is activated by HGPRTase, decreasing purine synthesis - myelosuppression

Question 8

examples of cytotoxic agents acting on microtubules

Answer 8

vincristine - may cause peripheral neuropathy, paralytic ileus

docetaxel - prevents microtubule depolymerisation and disassembly - may cause neutropenia

Question 9

examples of topoisomerase inhibitors

Answer 9

Irinotecan - inhibits topoisomerase I which prevents relaxation of supercoiled DNA - may cause myelosuppression

Question 10

moa and S/E of cisplatin

Answer 10

causes cross-linking in DNA

may cause ototoxicity, peripheral neuropathy, hypomagnesaemia

Question 11

investigating metastatic disease of unknown primary

Answer 11

do in all patients:
FBC, U&E, LFT, calcium, urinalysis, LDH
Chest X-ray
CT of chest, abdomen and pelvis
AFP and hCG

Myeloma screen (if lytic bone lesions)
Endoscopy (directed towards symptoms)
PSA (men)
CA 125 (women with peritoneal malignancy or ascites)
Testicular US (in men with germ cell tumours)
Mammography (in women with clinical or pathological features compatible with breast cancer)

Question 12

features of lung adenocarcinoma

Answer 12

typically peripheral
most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers

Question 13

features of squamous cell lung cancer

Answer 13

typically central
associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia
strongly associated with finger clubbing
cavitating lesions are more common than other types
hypertrophic pulmonary osteoarthropathy (HPOA)

Question 14

features of large cell lung carcinoma

Answer 14

typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG

Question 15

features of neoplastic spinal cord compression

Answer 15

back pain - earliest and most common symptom, worse on lying down/coughing

lower limb weakness

sensory loss and numbness

lesions above L1 - cause UMN signs in legs
lesions below L1 - LMN sx in legs and perianal numbness

tendon reflexes - increased below level of lesion, absent at level of lesion

Question 16

managing neoplastic spinal cord compression

Answer 16

whole MRI spine <24h of presentation

high dose oral dexamethasone

urgent oncological assessment for consideration of radiotherapy or surgery

Question 17

uses of positron emission tomograhy

Answer 17

form of nuclear imaging using fluorodeoxyglucose as radiotracer - allows metabolic activity to be generated using glucose uptake as proxy marker

used to evaluate primary and possible metastatic disease

Question 18

symptoms of spinal metastases

Answer 18

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

if neurological sx present - suspect spinal cord compression, whole spine MRI

Question 19

causes of superior vena cava obstruction

Answer 19

common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis

Question 19

features of superior vena cava obstruction

Answer 19

dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

Question 20

managing superior vena cava obstruction

Answer 20

endovascular stenting - sx relief

some malignancies - radical chemo/chemo-radio

Question 21

common tumour antigens

Answer 21

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 22

common tumour monoclonal antibodies

Answer 22

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