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Medicine > Oncology > Flashcards

Oncology Flashcards

0
Q

Give 3 tests you would do in a suspected neutropenic septic patient?

A

Blood culture
MSU
Swabs from exit sites or other infected foci

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1
Q

Define neutropenic sepsis?

A

Fever > 38 degrees OR > 37.5 over 1hr

Neutropenia < 0.5 OR < 1 & falling

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2
Q

Which Abx. would you administer in neutropenic sepsis?

A

IV Tazocin (IV Imipenem if penicillin allergic)

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3
Q

How can you prevent neutropenic sepsis? 3 things

A

Dose reduction of chemotherapy

Prophylactic GCSF (Granulocyte colony stimulating factor)

?Stop chemo

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4
Q

Give 5 symptoms that might be felt with a metastatic spinal chord compression?

A 
Pain
Weakness
Sensory change
Urinary retention
Constipation/Incontinence
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5
Q

What is the investigation of choice in MSCC?

A

MRI

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6
Q

Give 3 treatment options for MSCC?

A

Radiotherapy - mainstay Rx.

Steroids - high dose glucocorticoids (dexamethasone)

Surgery - with RT

Urgent chemotherapy - very sensitive tumours

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7
Q

Give 5 situations that you would consider surgery to treat MSCC?

A 
Single vertebral involvement
No evidence of widespread disease
Radio resistant tumour
To obtain diagnosis
Previous Radiotherapy to site
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8
Q

Give 5 causes of a Superior vena cava obstruction?

A

EXTRINSIC
Right sided tumours
Superior mediastinal lymphadenopathy

INTRINSIC
Thrombosis
Foreign body (catheter)
Tumour

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9
Q

Give 4 symptoms experienced with SVCC?

A 
Swelling of the face and upper body in general
Distended neck veins
SOB
Headache
Lethargy
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10
Q

Give 3 possible oncology related causes of hypercalcaemia?

A

Humoural - Tumour secretion of PTH

Osteolytic mets with local cytokine release

Tumour production of calcitrol

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11
Q

What’s the normal range of calcium?

A

2.1-2.6

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12
Q

Give 4 blood tests you would do in a suspected hypercalcaemia?

A 
Calcium
U&E - Dehydration?
PTH - Cause?
Phosphate - low in hyperparathyroidism
Myeloma screen - cause?
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13
Q

How do you manage hypercalcaemia?

A

Rehydration 1st
Bisphosphonates
Others: Calcitonin, corticosteroids
Managements of malignancy

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14
Q

What is tumour lysis syndrome?

A 
Metabolic complication of treatments of rapidly dividing cancers causing:
Hyperuricemia
Hyperkalaemia
Hyperphosphatemia
Acute renal failure
Hypocalcaemia
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15
Q

How do you manage tumour lysis syndrome prophylactically? 3 things

A

Prehydration and vigorous hydration throughout treatmenr
Monitor electrolytes and fluid balance
Allopurinol - Uric acid

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17
Q

Give 5 risk factors for developing breast cancer?

A

Age (over 50)

Early mernache and late menopause

Nulliparity and late age of 1st pregnancy

Family history - 1st degree (BRCA 1 & 2)

Exogenous oestrogens

Diet (fat, obesity, alcohol)

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17
Q

What is the triple assessment?

A 
Full clinical exam
Bilateral mammography (?with US)
FNA cytology (?with core biopsy)
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18
Q

Give 6 indications for referral to a breast clinic?

A 
Screen detected breast cancer
Breast lump
Pain
Nipple discharge 
Nipple retraction, distortion or eczema
Change in breast contour
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19
Q

Give 5 indications for a mastectomy?

A 
Patient choice
Tumour size >40mm
Multifocality of cancer
Recurrent cancer after conservative
Radiotherapy is contraindicated
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20
Q

What 2 risks are associated with aromatase inhibitor use?

A

Osteoporosis

Endometrial carcinoma

21
Q

How can a cancer develop resistance to treatment? 5 things

A 
Decreased drug uptake
Increased drug efflux
Increased DNA repair
Alteration of drug target
Increased catabolism
Increased drug detoxification
22
Q

Give 4 risk factors for developing prostate cancer?

A

Increasing Age
Family history
BRCA 2 gene mutation
Ethnicity (Black)

23
Q

Give 3 possible presentations of prostate ca?

A

Asymptommatic
Urinary symptoms
Bone pain

24
Q

Give 3 diagnostic tests for prostate ca?

A

DRE
PSA
Biopsy (Transrectal US)

25
Q

How can you manage metastatic prostate ca? 3 things

A

Hormonal - Surgical/Medical castration

Radiotherapy

Bisphosphanates

26
Q

Give 3 management options for localised prostate ca?

A

Active monitoring/watchful waiting

Radical prostatectomy

Radiotherapy

27
Q

Give 3 risk factors for developing bladder cancer?

A

Smoking
Occupational exposure
Schistosomiasis

28
Q

How often is the bowel screening and what does it involve?

A

Every 2 years
Ages 60-69
FOB & Colonoscopy

29
Q

Give 4 suspicious symptoms for colorectal ca?

A 
Rectal bleeding
Change in bowel habit
Weight loss
Anaemia
Palpable abdominal mass
30
Q

Give 3 non metastatic manifestations of bronchial carcinoma?

A

Inappropriate ADH secretion -
Hyponatraemia

Ectopic ACTH secretion - Cushing

Hypercalcaemia - PTH release

31
Q

Give 3 common presenting symptoms in bladder ca?

A

Haematuria
Dysuria
Increased frequency of micturition

32
Q

Give management options for superficial bladder ca?

A

Resection by diathermy

BCG or mytomycin C injections

33
Q

How can you treat muscle invasive bladder cancer?

A

Radiotherapy

Surgery

34
Q

What are common side effects seen in radiotherapy to the bladder? 3 things

A

Radiation fibrosis
Cystitis
Proctitis

35
Q

State 6 possible acute side effects of chemotherapy?

A

Myelosupression: anaemia, infection, bleeding (thrombocytopenia). The most serious problem being Neutropenic sepsis.

GI effects: nausea and vomiting, diarrhoea, constipation, fatigue,

Skin damage: oral mucositis, rash, skin changes, nail changes

Alopecia

Organ damage: especially the kidneys, liver, lungs and heart.

Gonadal failure: infertility
Teratogenicity

36
Q

Give 5 possible long term side effects of chemotherapy?

A 
Lung fibrosis
Cardiac dysfunction
Neurological damage
Renal impairment
Secondary malignancy
Psychological problems.
37
Q

Give 5 possible acute side effects of radiotherapy?

A 
General fatigue
Skin changes: erythema, dry desquamation
skin tanning, hair loss
GI effects
Myelosuppresion
Pneumonitis
38
Q

State 5 possible long term side effects of radiotherapy?

A 
Renal impairment
Neck fibrosis (woody texture)
Muscles of mastication fibrosis
Lymphodema
Dry mouth (xerostomia)
39
Q

Give 5 examples of hormonal and biological treatments?

A

Hormone
Tamoxifen (breast cancer) - Selective oestrogen receptor modulator (SERM) which blocks oestrogen receptors
GnRH agonist (prostate cancer) - excessive testerone stimulation of prostate leading to down regulating of receptors

Biological
Herceptin (breast) - monoclonal antibody targeting HER 2 receptors
Rituximab (non-hodgkin lymphoma) - B cell lysis
GCSF (granulocyte colony stimulating factor) - stimulated bone marrow to produce white cells

40
Q

Which age group is breast cancer screening undertaken?

A

Women 47-73 years old

41
Q

What factors are included in the Nottingham prognostic index for breast cancer?

A

Size of the lesion
Number of lymph nodes involved
Grade of tumour

42
Q

Give 5 common locations for lung cancer spread?

A 
Liver
Brain
Bone
Adrenal gland
Skin
43
Q

State 4 poor prognostic factors in breast cancer?

A 
Cancer >2cms
High grade (2/3)
Young patient
Metastasis present
Negative oestrogen/progesterone receptors
44
Q

Give 4 risk factors for developing malignant melanoma?

A

Sun exposure
FHx
Fair skinned people
Albinos

45
Q

How is melanoma diagnosed?

A

Glasgow 7 point checklist

46
Q

State 4 risk factors for developing colorectal carcinoma?

A

Environmental (high fat diet, alcohol, red meat)
IBD
Neoplastic polyps
Low fibre diet

47
Q

How is a malignant melanoma managed? 4 things

A

Use dermatoscope to analyse lesion
Refer to dermatologist
Excisional surgery
Biopsy sentinel nodes for mets

48
Q

When would you refer a ?Melanoma?

A 
ABCDE
Asymmetry
Border irregular
Colour irregularity
Diameter > 6mm
Evolving over time

Refer if >3

49
Q

Give 4 types of melanoma?

A

Nodular melanoma
Lentigo maligna melanoma
Superficial spreading melanoma
Acral lentiginous melanoma

Medicine (17 decks)

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