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Yr 4 - PassMed Corrections > Oncology > Flashcards

Oncology Flashcards

1
Q

What is the one chemo drug to have its dose calculated directly according to the renal function?

A

Carboplatin

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2
Q

Give an example of an anthracycline

A

Doxorubicin

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3
Q

2 key adverse effects of cisplatin?

A

1) Nephrotoxicity

2) Ototoxicity

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4
Q

Chemotherapy causes bone marrow suppression which can lead to leucopenia and thrombocytopenia.

What is the lowest point in this drop called?

A

The nadir

Typically occurs around 10 days after chemo (i.e. most risk for neutropenic sepsis)

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5
Q

What 2 types of chemotherapy drugs can cause cardiomyopathy?

A

1) Anthracyclines eg. doxorubicin

2) HER-2 receptor monoclonal antibodies (e.g. Herceptin)

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6
Q

How is radiotherapy delivered?

A

In fractions

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7
Q

In some cases, what can alopecia caused by chemo be controlled by?

A

Cold cap - reduces blood flow to scalp

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8
Q

What are the clinical signs of significant thrombocytopenia?

(4)

A

1) Petechial haemorrhage

2) Spontaneous epistaxis

3) Haematuria

4) Corneal haemorrhage

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9
Q

Presentation of pneumonitis?

A

Dry cough
SOB
Reduced exercise tolerance
Fatigue

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10
Q

Give 2 examples of platinum chemo agents

A

1) Cisplatin
2) Carboplatin

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11
Q

What type of chemotherapy agents can cause peripheral neuropathy and sensorineural hearing loss?

A

Platinum agents e.g. cisplatin

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12
Q

When may chemo be administered directly into the peritoneal cavity (i.e. intraperitoneal)?

A

Trans-coelomic spread e.g. ovarian cancer

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13
Q

How can you formally assess adrenal function?

A

Short synACTHen test

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14
Q

Which chemo drug is ototoxic?

A

Cisplatin

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15
Q

How may radiation pneumonitis present?

A

Cough, chest pain, fevers

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16
Q

What 2 cancers is brachytherapy often used in the management of?

A

1) Prostate
2) Cervical

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17
Q

What is the amount of energy absorbed in radiotherapy measured in?

A

Greys

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18
Q

What investigation can be used to look for bony mets in prostate cancer?

A

Isotope bone scan

Metastatic bone lesions take up more of the isotope, making them stand out on the scan.

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19
Q

1st line imaging in prostate cancer?

A

Multiparametric MRI

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20
Q

1st line biopsy in prostate cancer?

A

TRUS (transrectal US guided) biopsy

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21
Q

What grading system is used in prostate cancer?

A

Gleason grading system

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22
Q

What staging system is used in prostate cancer?

A

TNM

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23
Q

What Gleason score indicates:

a) high risk
b) intermediate risk
c) low risk

for prostate cancer?

A

a) ≥8

b) 7 (N.B. 3+4 is lower risk than 4+3)

c) ≤6

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24
Q

What is the Gleason Grading System based on?

A

Histology from prostate biopsy

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25
The Gleason score will be made up of two numbers added together for the total score (e.g. 3 + 4 = 7). What are these 2 numbers?
First number --> grade of most prevalent pattern Second number --> grade of 2nd most prevalent pattern
26
What is the decision to biopsy in prostate cancer based on?
1) Multiparametric MRI finding (i.e. Likert scale) 2) Clinical suspicion (PR exam & PSA)
27
What Likert scale indicates the need for a prostate biopsy?
≥3
28
Give 2 classes of drugs used in hormone therapy options in prostate cancer
1) GnRH agonists e.g. goserelin 2) Androgen-receptor blockers e.g. bicalutamide
29
What are the majority of prostate cancers?
Adenocarcinomas
30
What are 2 key complications of a radical prostatectomy?
1) ED 2) urinary incontinence
31
What genes are involved in HNPCC vs FAP?
HNPCC --> DNA mismatch repair (MMR) genes FAP --> APC genes (tumour suppressor)
32
Inheritance of FAP?
Autosomal dominant
33
Inheritance of HNPCC?
Autosomal dominant
34
Where do most colorectal cancers occur?
In the rectum (40%)
35
Does FAP or HNPCC cause adenomas?
FAP In HNPCC, tumours develop in isolation
36
What do FIT tests look for?
Amount of haemoglobin in stools
37
What class of drug is bicalutamide?
Androgen receptor blocker
38
Where do the majority of prostate cancers grow?
In the peripheral zone of the prostate
39
Give the screening programme for: a) breast cancer b) cervical cancer c) colorectal cancer
a) 50-71 y/o every 3 years b) 25-49 y/o every 3 years, 50-64 every 5 years c) 60-74 y/o every 2 years
40
What is removed in a right hemicolectomy?
Caecum, ascending colon and proximal transverse colon.
41
What is removed in a left hemicolectomy?
Distal transverse colon, descending colon
42
What is removed in a low anterior resection?
Sigmoid colon & upper rectum Anastamosis then made between colon & rectum
43
What is low anterior resection syndrome?
May occur after resection of portion of bowel from rectum, with anastomosis between the colon and rectum. Symptoms: - Urgency and frequency of bowel movements - Faecal incontinence - Difficulty controlling flatulence
44
NICE two week wait referral guidelines for colorectal cancer:
1) ≥40 with abdo pain and unexplained weight loss 2) ≤50 with unexplained rectal bleeding 3) ≥60 with cahnge in bowel habit or iron deficiency anaemia
45
What is Hartmann’s procedure?
Usually performed in an emergency. Removal of recto-sigmoid colon and creation of colostomy. Rectal stump is sutured closed.
46
What is the purpose of TURP?
Used in the mx of bladder outlofw obstruction in BPH
47
What surgical intervention is required in carcinoma of the splenic flexure?
Left hemicolectomy
48
What surgical intervention is required in carcinoma of the caecum?
Right hemicolectomy
49
What surgical intervention is required in low rectal cancer?
Low anterior resection
50
What surgical intervention is required in rectal cancer on the anal verge?
Abdomino-perineal excision of rectum
51
What gene mutations are associated with HNPCC?
MSH2/MLH1 gene mutations (these are MMR genes)
52
Why is epidural analgesia commonly seen on GI surgery wards?
Epidurals are associated with a faster return to normal bowel function after abdominal surgery.
53
What 3 cancers at patients at risk of following radiotherapy for prostate cancer?
1) bladder 2) colon 3) rectal
54
What investigation can be used to assess if there are any leaks in a colorectal anastomosis?
A gastrografin enema
55
Why is gastrogafin preferred to barium in enemas to assess if there are any leaks in a colorectal anastomosis?
gastrografin is preferred over barium as it is less toxic if it leaks into the abdominal cavity
56
What develops in Peutz-Jeghers syndrome?
hamartomatous polyps in the GI tract (mainly small bowel)
57
What is a common presenting complaint in Peutz-Jeghers syndrome?
small bowel obstruction, often due to intussusception
58
Mechansim of tamsulosin?
Alpha blocker (a-1 antagonist)
59
How long should PSA testing be delayed following prostatitis?
4 weeks
60
How long should PSA testing be delayed following vigorous exercise?
48 hours
61
What is the first-line investigation in suspected prostate cancer?
Multiparametric MRI
62
How long should PSA testing be delayed following prostate biopsy?
6 weeks
63
How long should PSA testing be delayed following UTI?
4 weeks
64
How long should PSA testing be delayed following PR exam?
1 week
65
What carcinogen can cause hepatic angiosarcoma?
Vinyl chloride
66
What carcinogen can cause bladder cancer (transitional cell carcinoma)?
Aniline dyes
67
4 main adverse effects of cisplatin?
1) ototoxicity 2) nephrotoxicity 3) peripheral neuropathy 4) hypomagnesaemia
68
Mechanism of methotrexate?
Inhibits dihydrofolate reductase
69
Which type of lung cancer has the strongest association with finger clubbing?
Squamous cell carcinoma
70
At what eGFR does dose of nitrofurantoin for UTI need to be reduced?
<45
71
Duke’s staging system may be used to stage bowel cancer. Describe stages A, B, C, and D
A - inner lining of bowel, may have slightly grown into muscle layer B - cancer has grown through muscle wall C - spread to at least 1 local lymph node D - spread to another part of the body e.g. lungs
72
What tumours are associated with myasthenia gravis?
Thymoma
73
Which 2 tumour markers are most useful in detecting recurrence of testicular teratoma?
1) AFP 2) b-HCG
74
Which chemo drug can cause liver fibrosis?
methotrexate
75
Which type of lung cancer has the strongest association with smoking?
Squamous cell carcinoma
76
What is chance of inheriting BRCA 1 mutation?
50% (boys and girls)
77
What treatment is indicated in node positive breast cancer (i.e. cancer has spread into the lymphatic system)?
FEC-D chemo
78
What is the main risk factor for cholangiocarcinoma?
Primary sclerosing cholangitis (PSC)
79
In what size tumours is a wide local excision in breast cancer favoured?
<4cm
80
What are the 4 adverse effects of methotrexate?
1) lung fibrosis 2) liver fibrosis 3) mucositis 4) myelosuppression
81
Which infection increases the risk of HCC?
Chronic hep B infection
82
1st line for breathlessnes in end of life?
Morphine sulphate SC
83
What type of lung cancer is most associated with gynaecomastia?
Adenocarcinoma
84
What are the 3 most common paraneoplastic syndromes associated with small cell lung cancer?
1) Ectopic ACTH production 2) Lambert Eaton syndrome 3) SIADH
85
Prophylaxis of tumour lysis syndrome?
1) Aggressive IV rehydration 2) Allopurinol
86
Initially, what is therapy with GnRH agonists in prostate cancer covered with?
Anti-androgens e.g. cyproterone acetate
87
Initially, GnRH agonists in mx of prostate cancer can cause a 'testosterone flare'. How may this present?
- bone pain - bladder obstruction etc
88
What type of lung cancer are cavitating lesions more common with?
Squamous cell
89
What are the 3 most common paraneoplastic syndromes associated with small cell lung cancer?
1) Lambert eaton 2) SIADH 3) Ectopic ACTH
90
It's important to test for deficiency of what enzyme prior to treatment with 5FU (Fluorouracil) chemotherapy?
DPD deficiency As without enough DPD enzyme, these chemotherapy drugs build up in the body and cause more severe side effects than usual.
91
What is the most common side effect of doxorubicin?
Fatigue
92
How can platelets be an indicator of lung cancer?
Raised platelets can be an indicator of lung cancer
93
wedge-shaped opacification on a CXR?
Consider PE
94
What cancer can pernicious anaemia predispose to?
Gastric carcinoma
95
How can pancoast tumours present? (2)
1) Horner's syndrome 2) Hoarseness (due to pressing on recurrent laryngeal nerve)
96
What type of lung cancer is most associated with hyperthyroidism?
Squamous cell (ectopic TSH)
97
What is the most common type of oral cancer?
Squamous cell carcinoma
98
What is a life threatening complication that can occur after TRUS prostate biopsy?
Urosepsis
99
Facial rash plus lymphadenopathy ?
Sarcoidosis
100
How are Pancoast tumours diagnosed?
CT chest
101
What can be used to treat symptoms of carcinoid syndrome?
Ocreotide (suppresses hormones)
102
What cardiac defects may be seen in carcinoid syndrome?
Right sided heart pathology --> tricuspid insufficiency & pulmonary stenosis Mneumonic: TIPS
103

Yr 4 - PassMed Corrections (36 decks)

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