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Oncology Flashcards

1
Q

Most common tumour causing bone mets

A

Prostate
Breast
Lung

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2
Q

Most common bone mets site

A

Spine
Pelvis
Ribs
Skull
Long bones

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3
Q

Symptoms that can indicate bone mets

A

Pathological fractures
Hypercalcaemia
Raised ALP

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4
Q

Different types of carcinogens and what cancers they can cause

A

Aflatoxin = liver
Aniline dyes = bladder
Asbestos = mesothelioma and bronchial carcinoma
Nitrosamines = oesophageal and gastric cancer
Vinyl chloride = hepatic angiosarcoma

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5
Q

Which subtypes of HPV are associated with cervical cancer

A

16
18
33

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6
Q

What are koilocytes

A

Endocervical cells that are affected HPV

Have the following features:
- enlarged nucleus
- irregular nuclear membrane contour
- the nucleus stains darker than normal
- perinuclear halo may be seen

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7
Q

Risk factors for the development of chemotherapy side effects

A

Anxiety
Age <50
Concurrent use of opioids
Type of chemotherapy

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8
Q

What is cyclophosphamide

A

An alkylating agent used in the management of cancer and autoimmune conditions
Works by causing cross linking of DNA

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9
Q

Adverse effects of cyclophosphamide

A

Haemorrhagic cystitis : incidence reduced by the use of hydration and mesna

Myelosuppression

TCC

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10
Q

What is mesna

A

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

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11
Q

How does bleomycin (cytotoxic antibiotic) work

A

Degrades preformed DNA
(Can cause lung fibrosis)

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12
Q

How do anthracyclines eg doxorubicin (cytotoxic antibiotic) work

A

Stabilises DNA-topoisomerase II complex inhibits DNA and RNA synthesis

Can cause cardiomyopathy

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13
Q

How does methotrexate (antimetabolite) work

A

Inhibits dihydrofolate reductase and thymidylate synthesis

Can cause Myelosuppression, mucosities, liver fibrosis and lung fibrosis

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14
Q

How does fluorouracil (5-FU) work (antimetabolite)

A

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

Can cause Myelosuppression, mycosiites, dermatitis

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15
Q

How does 6-mercaptopurine work (antimetabolite)

A

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

Causes Myelosuppression

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16
Q

How does cytarabine (antimetabolite) work

A

Pyrimidine antagonist
Interferes with DNA synthesis specifically at the S phase of the cell cycle and inhibits DNA polymerase

Can cause Myelosuppression and ataxia

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17
Q

How does vincristine and vinblastine work

A

Inhibits formation of microtubules

Can cause peripheral neuropathy, paralytic ileus and Myelosuppression

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18
Q

How does docetaxel work

A

Prevents microtubule depolymerisation and disassembly, decreasing free tubulin

Can cause neutropenia

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19
Q

How does irinotecan (topoisomerase inhibitor) work

A

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA

Can cause Myelosuppression

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20
Q

How does cisplatin work

A

Causes cross linking in DNA

Can cause ototoxicity, peripheral neuropathy, hypomagnesaemia

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21
Q

How does hydroxyurea work

A

Inhibits ribonucleotide reductase, decreasing DNA synthesis

Causes Myelosuppression

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22
Q

What is Li-fraumeni syndrome

A

Autosomal dominant
Consists of germline mutations to p53 tumour suppressor genes
High incidence of malignancies particularly sarcomas and leukaemias

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23
Q

What are BRCA 1 and BRCA 2 genes

A

Carried on chromosome 17 (BRCA 1) and chromosome 13 (BRCA 2)
Linked to developing breast cancer (60% risk)
Associated risk of developing ovarian cancer (55% with BRCA1 and 25% with BRCA 2)

BRCA 2 associated with PCa in men

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24
Q

What is lynch syndrome

A

Autosomal dominant
Develop colonic cancer and endometrial cancer at young age
80% of affected individuals get colonic and / or endometrial cancer

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25
What is gardeners syndrome
Autosomal dominant familial colorectal polyposis Multiple colonic polyps Extra colonic disease include: skull osteoma, thyroid cancer and epidermoid cysts Desmond tumours seen in 15% Mutation of APC gene on chromosome 5 Most undergo colectomy to reduce risk of colorectal cancer
26
What investigations are used for investigating metastatic disease of unknown primary
FBC, U&E, LFT, calcium, urinalysis, LDH CXR CT chest, abdo, pelvis AFP and hCG
27
What are the 3 main subtypes of non small cell lung cancer
Squamous cell cancer Adenocarcinoma Large cell lung cancer
28
What are the features of squamous cell lung cancer
Typically central Associated with PTHrP secretion -> hypercalcaemia Associated with clubbing Cavitating lesions Hypertrophic pulmonary osteoarthropathy
29
What are the features of adenocarcinoma of the lung
Typically peripheral Most common type of lung cancer in non smokers although majority of patients who develop it are smokers
30
Features of large cell lung carcinoma
Typically peripheral Anaplastic, poorly differentiated tumours with a poor prognosis May secrete B-hCG
31
What is neoplastic spinal cord compression
An oncological emergency Usually due to vertebral body metastases
32
Features of neoplastic spinal cord compression
Back pain Lower limb weakness Sensory changes: sensory loss and numbness Neurological signs
33
Investigations for suspected neoplastic spinal cord compression
Urgent MRI within 24h of presentation
34
Management of neoplastic spinal cord compression
High dose oral dexamethasone Urgent oncological assessment for consideration of radioatherapy or surgery
35
Symptoms / findings of spinal metastases
Unrelenting lumbar back pain Any thoracic or cervical back pain Worse with sneezing, coughing or straining Nocturnal Associated with tenderness
36
What is superior vena cava obstruction
An oncological emergency caused by compression of the SVC Most commonly associated with lung cancer
37
Features of SVC obstruction
Dyspnoea Swelling of face, neck and arms - conjunctival and periorbital oedema may be seen Headache : often worse in morning Visual disturbance Pulseless jugular venous distension
38
Causes of SVC obstruction
Common malignancies : small cell lung cancer, lymphoma Other malignancies: metastatic seminoma, kaposi’s sarcoma, breast cancer Aortic aneurysm Mediastinal fibrosis Goitre SVC thrombosis
39
Management of SVC obstruction
Endovascular stenting for symptoms relief Radical chemotherapy or chemo-radiotherapy for certain malignancies Glucocorticoids sometimes given but evidence is weak
40
What are the types of tumour markers
Monoclonal antibodies Tumour antigens Enzymes Hormones
41
Examples of monoclonal antibody tumour markers and their association
CA 125 - ovarian cancer CA 19-9 - pancreatic cancer CA 15-3 breast cancer
42
Types of tumour antigens and their association
PSA - prostatic carcinoma AFP - hepatocellular carcinoma, teratoma CEA - colorectal cancer S-100 - melanoma, schwannomas Bombesin - small cell lung cancer, gastric cancer, neuroblastoma
43
Epidemiology of neoplastic spinal cord compression
10 cases per 100,000 person years Peak incidence 60-70y Sex ratio 1:1
44
What can neoplastic spinal cord compression be due to
Metastatic deposits Primary cancer of the spine
45
What can neoplastic spinal cord compression be due to
Metastatic deposits Primary cancer of the spine
46
What are the 3 most common primary cancers that cause bone mets
Breast: 21% of spinal mets Lung: 19% of spinal mets (more common in small cell lung cancer) Prostate: 8% of spinal mets
47
Pathophysiology of spinal cord compression
Mets grow in the vertebrae or soft tissues They destroy normal spinal architecture leading to pain and compression Pressure on spinal cord causes limb weakness / sphincter disturbance
48
Clinical features of neoplastic spinal cord compression
Back pain - worse on lying down / coughing Lower limb weakness Sensory changes: sensory loss and numbness Neurological signs
49
Investigations for neoplastic spinal cord compression
MRI spine within 24h of presentation (gold standard) Multidetector CT
50
What cancer is SVC obstruction associated with
Lung
51
Causes of SVC obstruction
Malignancy: non small cell lung cancer, lymphoma, metastatic seminoma, kaposi’s sarcoma, breast cancer Aortic aneurysms Mediastinal fibrosis Goitre SVC thrombosis
52
Complications of SVC obstruction
Severe laryngeal oedema and airway obstruction Cerebral oedema -> neurological signs Low cardiac output leads to hypotension PE Death
53
Features of SVC obstruction
Dyspnoea - most common, exacerbated lying down Swelling of the face Chest pain Headache Visual disturbance Pulseless jugular venous distension Collateral vein development on chest wall, abdo or back Stridor (compressive) Dysphagia (compressive) Hoarseness (compressive)
54
Diagnosis of SVC obstruction
CXR - widened mediastinum or mass lesion in lung CT thorax MRI chest Doppler US of upper extremities Venography Biopsy
55
Symptom relief SVC obstruction
Elevation of head of bed Supplemental oxygen Corticosteroids and diuretics Radiotherapy or percutaneous stenting Urgent treatment for life threatening situations
56
Symptom relief SVC obstruction
Elevation of head of bed Supplemental oxygen Corticosteroids and diuretics Radiotherapy or percutaneous stenting Urgent treatment for life threatening situations
57
What should be done if neoplastic spinal cord compression is suspected
High dose oral dexamethasone whilst awaiting investigations
58
Which type of lung cancer has the strongest association with smoking
Squamous cell carcinoma
59
Red flags for head and neck cancer
Lump in mouth or on lip Mouth ulcers >3 weeks Erythroplakia or erythroleukoplakia Persistent neck lump Unexplained voice hoarseness Unexplained thyroid lump
60
What is cetuximab used for
A monoclonal antibody used in treating SCC Targets epidermal growth factor receptor
61
What is the most useful follow up investigation for testicular teratoma recurrence
Alpha feta protein and beta HCG
62
What does a PET scan demonstrate
Glucose uptake
63
What is mesothelioma
A lung malignancy affecting mesothelial cells of the pleura Linked to asbestos inhalation Latent period of up to 45 years
64
PC of lung cancer
SOB Cough Haemoptysis Clubbing Pneumonia Weight loss Lymphadenopathy (supraclavicular)
65
2WW lung cancer pathway referral
>40 with: - clubbing - lymphadenopathy - recurrent or persistent chest infections - raised platelet count - chest signs of lung cancer
66
CXR findings that indicate lung cancer
Hilar enlargement Peripheral opacity Pleural effusion Collapse
67
Lugano classification of lymphoma
Stage 1: 1 node or group of nodes Stage 2: in more than one group but on same side of the diaphragm Stage 3: lymph nodes above and below diaphragm Stage 4: widespread involvement including organs
68
Red flag headache symptoms
Constant Nocturnal Worse on waking Worse on coughing, straining or bending forward Vomiting Papilloedema on fundoscopy
69
Features of raised ICP
Altered mental state Visual field defects Seizures Unilateral ptosis 3rd and 6th nerve palsies
70
Main 3 types of gliomas
Astrocytoma Oligodendroglioma Ependymoma
71
Complications of pituitary tumours
Can press on optic chiasm causing bitemporal hemianopia
72
Management of pituitary tumours
Trans-sphenoidal surgery Radiotherapy Bromocriptine to block excess prolactin Somatostatin analogues to block GH
73
Adverse effects of vincristine
Peripheral neuropathy Paralytic ileus Myelosuppression
74
Adverse effects of docetaxel
Neutropenia
75
Adverse effects of bleomycin
Lung fibrosis
76
Adverse effects of cyclophosphamide
Haemorrhagic cystitis Myelosuppression TCC
77
Adverse effects of cisplatin
Ototoxicity Peripheral neuropathy Hypomagnesaemia
78
Risk factors for development of chemotherapy side effects
Anxiety <50 Concurrent use of opioids Type of chemo used
79
Adverse effects of anthracyclines eg doxorubicin
Cardiomyopathy
80
Describe imaging of glioblastoma
Solid tumour with central necrosis and a rim that enhances with contrast Disruption of BBB - vasogenic oedema
81
Describe meningioma
Benign, extrinsic tumours of the CNS Arise from arachnoid cap cells of the meninges located next to the dura Cause symptoms by compression Located typically at falx cerebri, superior Sagittarius sinus, convexity or skull base

Integrated Med (6 decks)

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