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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
Q

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?

A

First number –> grade of most prevalent pattern

Second number –> grade of 2nd most prevalent pattern

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26
Q

What is the decision to biopsy in prostate cancer based on?

A

1) Multiparametric MRI finding (i.e. Likert scale)

2) Clinical suspicion (PR exam & PSA)

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27
Q

What Likert scale indicates the need for a prostate biopsy?

A

≥3

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28
Q

Give 2 classes of drugs used in hormone therapy options in prostate cancer

A

1) GnRH agonists e.g. goserelin

2) Androgen-receptor blockers e.g. bicalutamide

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29
Q

What are the majority of prostate cancers?

A

Adenocarcinomas

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30
Q

What are 2 key complications of a radical prostatectomy?

A

1) ED

2) urinary incontinence

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31
Q

What genes are involved in HNPCC vs FAP?

A

HNPCC –> DNA mismatch repair (MMR) genes

FAP –> APC genes (tumour suppressor)

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32
Q

Inheritance of FAP?

A

Autosomal dominant

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33
Q

Inheritance of HNPCC?

A

Autosomal dominant

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34
Q

Where do most colorectal cancers occur?

A

In the rectum (40%)

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35
Q

Does FAP or HNPCC cause adenomas?

A

FAP

In HNPCC, tumours develop in isolation

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36
Q

What do FIT tests look for?

A

Amount of haemoglobin in stools

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37
Q

What class of drug is bicalutamide?

A

Androgen receptor blocker

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38
Q

Where do the majority of prostate cancers grow?

A

In the peripheral zone of the prostate

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39
Q

Give the screening programme for:

a) breast cancer
b) cervical cancer
c) colorectal cancer

A

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

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40
Q

What is removed in a right hemicolectomy?

A

Caecum, ascending colon and proximal transverse colon.

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41
Q

What is removed in a left hemicolectomy?

A

Distal transverse colon, descending colon

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42
Q

What is removed in a low anterior resection?

A

Sigmoid colon & upper rectum

Anastamosis then made between colon & rectum

43
Q

What is low anterior resection syndrome?

A

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
Q

NICE two week wait referral guidelines for colorectal cancer:

A

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
Q

What is Hartmann’s procedure?

A

Usually performed in an emergency.

Removal of recto-sigmoid colon and creation of colostomy.

Rectal stump is sutured closed.

46
Q

What is the purpose of TURP?

A

Used in the mx of bladder outlofw obstruction in BPH

47
Q

What surgical intervention is required in carcinoma of the splenic flexure?

A

Left hemicolectomy

48
Q

What surgical intervention is required in carcinoma of the caecum?

A

Right hemicolectomy

49
Q

What surgical intervention is required in low rectal cancer?

A

Low anterior resection

50
Q

What surgical intervention is required in rectal cancer on the anal verge?

A

Abdomino-perineal excision of rectum

51
Q

What gene mutations are associated with HNPCC?

A

MSH2/MLH1 gene mutations (these are MMR genes)

52
Q

Why is epidural analgesia commonly seen on GI surgery wards?

A

Epidurals are associated with a faster return to normal bowel function after abdominal surgery.

53
Q

What 3 cancers at patients at risk of following radiotherapy for prostate cancer?

A

1) bladder
2) colon
3) rectal

54
Q

What investigation can be used to assess if there are any leaks in a colorectal anastomosis?

A

A gastrografin enema

55
Q

Why is gastrogafin preferred to barium in enemas to assess if there are any leaks in a colorectal anastomosis?

A

gastrografin is preferred over barium as it is less toxic if it leaks into the abdominal cavity

56
Q

What develops in Peutz-Jeghers syndrome?

A

hamartomatous polyps in the GI tract (mainly small bowel)

57
Q

What is a common presenting complaint in Peutz-Jeghers syndrome?

A

small bowel obstruction, often due to intussusception

58
Q

Mechansim of tamsulosin?

A

Alpha blocker (a-1 antagonist)

59
Q

How long should PSA testing be delayed following prostatitis?

A

4 weeks

60
Q

How long should PSA testing be delayed following vigorous exercise?

A

48 hours

61
Q

What is the first-line investigation in suspected prostate cancer?

A

Multiparametric MRI

62
Q

How long should PSA testing be delayed following prostate biopsy?

A

6 weeks

63
Q

How long should PSA testing be delayed following UTI?

A

4 weeks

64
Q

How long should PSA testing be delayed following PR exam?

A

1 week

65
Q

What carcinogen can cause hepatic angiosarcoma?

A

Vinyl chloride

66
Q

What carcinogen can cause bladder cancer (transitional cell carcinoma)?

A

Aniline dyes

67
Q

4 main adverse effects of cisplatin?

A

1) ototoxicity
2) nephrotoxicity
3) peripheral neuropathy
4) hypomagnesaemia

68
Q

Mechanism of methotrexate?

A

Inhibits dihydrofolate reductase

69
Q

Which type of lung cancer has the strongest association with finger clubbing?

A

Squamous cell carcinoma

70
Q

At what eGFR does dose of nitrofurantoin for UTI need to be reduced?

A

<45

71
Q

Duke’s staging system may be used to stage bowel cancer.

Describe stages A, B, C, and D

A

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
Q

What tumours are associated with myasthenia gravis?

A

Thymoma

73
Q

Which 2 tumour markers are most useful in detecting recurrence of testicular teratoma?

A

1) AFP

2) b-HCG

74
Q

Which chemo drug can cause liver fibrosis?

A

methotrexate

75
Q

Which type of lung cancer has the strongest association with smoking?

A

Squamous cell carcinoma

76
Q

What is chance of inheriting BRCA 1 mutation?

A

50% (boys and girls)

77
Q

What treatment is indicated in node positive breast cancer (i.e. cancer has spread into the lymphatic system)?

A

FEC-D chemo

78
Q

What is the main risk factor for cholangiocarcinoma?

A

Primary sclerosing cholangitis (PSC)

79
Q

In what size tumours is a wide local excision in breast cancer favoured?

A

<4cm

80
Q

What are the 4 adverse effects of methotrexate?

A

1) lung fibrosis
2) liver fibrosis
3) mucositis
4) myelosuppression

81
Q

Which infection increases the risk of HCC?

A

Chronic hep B infection

82
Q

1st line for breathlessnes in end of life?

A

Morphine sulphate SC

83
Q

What type of lung cancer is most associated with gynaecomastia?

A

Adenocarcinoma

84
Q

What are the 3 most common paraneoplastic syndromes associated with small cell lung cancer?

A

1) Ectopic ACTH production

2) Lambert Eaton syndrome

3) SIADH

85
Q

Prophylaxis of tumour lysis syndrome?

A

1) Aggressive IV rehydration

2) Allopurinol

86
Q

Initially, what is therapy with GnRH agonists in prostate cancer covered with?

A

Anti-androgens e.g. cyproterone acetate

87
Q

Initially, GnRH agonists in mx of prostate cancer can cause a ‘testosterone flare’.

How may this present?

A
  • bone pain
  • bladder obstruction

etc

88
Q

What type of lung cancer are cavitating lesions more common with?

A

Squamous cell

89
Q

What are the 3 most common paraneoplastic syndromes associated with small cell lung cancer?

A

1) Lambert eaton

2) SIADH

3) Ectopic ACTH

90
Q

It’s important to test for deficiency of what enzyme prior to treatment with 5FU (Fluorouracil) chemotherapy?

A

DPD deficiency

As without enough DPD enzyme, these chemotherapy drugs build up in the body and cause more severe side effects than usual.

91
Q

What is the most common side effect of doxorubicin?

A

Fatigue

92
Q

How can platelets be an indicator of lung cancer?

A

Raised platelets can be an indicator of lung cancer

93
Q

wedge-shaped opacification on a CXR?

A

Consider PE

94
Q

What cancer can pernicious anaemia predispose to?

A

Gastric carcinoma

95
Q

How can pancoast tumours present?

(2)

A

1) Horner’s syndrome

2) Hoarseness (due to pressing on recurrent laryngeal nerve)

96
Q

What type of lung cancer is most associated with hyperthyroidism?

A

Squamous cell (ectopic TSH)

97
Q

What is the most common type of oral cancer?

A

Squamous cell carcinoma

98
Q

What is a life threatening complication that can occur after TRUS prostate biopsy?

A

Urosepsis

99
Q

Facial rash plus lymphadenopathy ?

A

Sarcoidosis

100
Q

How are Pancoast tumours diagnosed?

A

CT chest

101
Q

What can be used to treat symptoms of carcinoid syndrome?

A

Ocreotide (suppresses hormones)

102
Q

What cardiac defects may be seen in carcinoid syndrome?

A

Right sided heart pathology –> tricuspid insufficiency & pulmonary stenosis

Mneumonic: TIPS

103
Q
A

Yr 4 - PassMed Corrections (36 decks)

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