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Integrated Med > Oncology > Flashcards

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
Q

What is gardeners syndrome

A

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

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26
Q

What investigations are used for investigating metastatic disease of unknown primary

A

FBC, U&E, LFT, calcium, urinalysis, LDH
CXR
CT chest, abdo, pelvis
AFP and hCG

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27
Q

What are the 3 main subtypes of non small cell lung cancer

A

Squamous cell cancer
Adenocarcinoma
Large cell lung cancer

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28
Q

What are the features of squamous cell lung cancer

A

Typically central
Associated with PTHrP secretion -> hypercalcaemia
Associated with clubbing
Cavitating lesions
Hypertrophic pulmonary osteoarthropathy

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29
Q

What are the features of adenocarcinoma of the lung

A

Typically peripheral
Most common type of lung cancer in non smokers although majority of patients who develop it are smokers

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30
Q

Features of large cell lung carcinoma

A

Typically peripheral
Anaplastic, poorly differentiated tumours with a poor prognosis
May secrete B-hCG

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31
Q

What is neoplastic spinal cord compression

A

An oncological emergency
Usually due to vertebral body metastases

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32
Q

Features of neoplastic spinal cord compression

A

Back pain
Lower limb weakness
Sensory changes: sensory loss and numbness
Neurological signs

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33
Q

Investigations for suspected neoplastic spinal cord compression

A

Urgent MRI within 24h of presentation

34
Q

Management of neoplastic spinal cord compression

A

High dose oral dexamethasone
Urgent oncological assessment for consideration of radioatherapy or surgery

35
Q

Symptoms / findings of spinal metastases

A

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

36
Q

What is superior vena cava obstruction

A

An oncological emergency caused by compression of the SVC
Most commonly associated with lung cancer

37
Q

Features of SVC obstruction

A

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
Q

Causes of SVC obstruction

A

Common malignancies : small cell lung cancer, lymphoma
Other malignancies: metastatic seminoma, kaposi’s sarcoma, breast cancer
Aortic aneurysm
Mediastinal fibrosis
Goitre
SVC thrombosis

39
Q

Management of SVC obstruction

A

Endovascular stenting for symptoms relief

Radical chemotherapy or chemo-radiotherapy for certain malignancies

Glucocorticoids sometimes given but evidence is weak

40
Q

What are the types of tumour markers

A

Monoclonal antibodies
Tumour antigens
Enzymes
Hormones

41
Q

Examples of monoclonal antibody tumour markers and their association

A

CA 125 - ovarian cancer
CA 19-9 - pancreatic cancer
CA 15-3 breast cancer

42
Q

Types of tumour antigens and their association

A

PSA - prostatic carcinoma
AFP - hepatocellular carcinoma, teratoma
CEA - colorectal cancer
S-100 - melanoma, schwannomas
Bombesin - small cell lung cancer, gastric cancer, neuroblastoma

43
Q

Epidemiology of neoplastic spinal cord compression

A

10 cases per 100,000 person years
Peak incidence 60-70y
Sex ratio 1:1

44
Q

What can neoplastic spinal cord compression be due to

A

Metastatic deposits
Primary cancer of the spine

45
Q

What can neoplastic spinal cord compression be due to

A

Metastatic deposits
Primary cancer of the spine

46
Q

What are the 3 most common primary cancers that cause bone mets

A

Breast: 21% of spinal mets
Lung: 19% of spinal mets (more common in small cell lung cancer)
Prostate: 8% of spinal mets

47
Q

Pathophysiology of spinal cord compression

A

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
Q

Clinical features of neoplastic spinal cord compression

A

Back pain - worse on lying down / coughing
Lower limb weakness
Sensory changes: sensory loss and numbness
Neurological signs

49
Q

Investigations for neoplastic spinal cord compression

A

MRI spine within 24h of presentation (gold standard)
Multidetector CT

50
Q

What cancer is SVC obstruction associated with

A

Lung

51
Q

Causes of SVC obstruction

A

Malignancy: non small cell lung cancer, lymphoma, metastatic seminoma, kaposi’s sarcoma, breast cancer

Aortic aneurysms

Mediastinal fibrosis

Goitre

SVC thrombosis

52
Q

Complications of SVC obstruction

A

Severe laryngeal oedema and airway obstruction
Cerebral oedema -> neurological signs
Low cardiac output leads to hypotension
PE
Death

53
Q

Features of SVC obstruction

A

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
Q

Diagnosis of SVC obstruction

A

CXR - widened mediastinum or mass lesion in lung
CT thorax
MRI chest
Doppler US of upper extremities
Venography
Biopsy

55
Q

Symptom relief SVC obstruction

A

Elevation of head of bed
Supplemental oxygen
Corticosteroids and diuretics
Radiotherapy or percutaneous stenting
Urgent treatment for life threatening situations

56
Q

Symptom relief SVC obstruction

A

Elevation of head of bed
Supplemental oxygen
Corticosteroids and diuretics
Radiotherapy or percutaneous stenting
Urgent treatment for life threatening situations

57
Q

What should be done if neoplastic spinal cord compression is suspected

A

High dose oral dexamethasone whilst awaiting investigations

58
Q

Which type of lung cancer has the strongest association with smoking

A

Squamous cell carcinoma

59
Q

Red flags for head and neck cancer

A

Lump in mouth or on lip
Mouth ulcers >3 weeks
Erythroplakia or erythroleukoplakia
Persistent neck lump
Unexplained voice hoarseness
Unexplained thyroid lump

60
Q

What is cetuximab used for

A

A monoclonal antibody used in treating SCC
Targets epidermal growth factor receptor

61
Q

What is the most useful follow up investigation for testicular teratoma recurrence

A

Alpha feta protein and beta HCG

62
Q

What does a PET scan demonstrate

A

Glucose uptake

63
Q

What is mesothelioma

A

A lung malignancy affecting mesothelial cells of the pleura

Linked to asbestos inhalation

Latent period of up to 45 years

64
Q

PC of lung cancer

A

SOB
Cough
Haemoptysis
Clubbing
Pneumonia
Weight loss
Lymphadenopathy (supraclavicular)

65
Q

2WW lung cancer pathway referral

A

> 40 with:
- clubbing
- lymphadenopathy
- recurrent or persistent chest infections
- raised platelet count
- chest signs of lung cancer

66
Q

CXR findings that indicate lung cancer

A

Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

67
Q

Lugano classification of lymphoma

A

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
Q

Red flag headache symptoms

A

Constant
Nocturnal
Worse on waking
Worse on coughing, straining or bending forward
Vomiting
Papilloedema on fundoscopy

69
Q

Features of raised ICP

A

Altered mental state
Visual field defects
Seizures
Unilateral ptosis
3rd and 6th nerve palsies

70
Q

Main 3 types of gliomas

A

Astrocytoma
Oligodendroglioma
Ependymoma

71
Q

Complications of pituitary tumours

A

Can press on optic chiasm causing bitemporal hemianopia

72
Q

Management of pituitary tumours

A

Trans-sphenoidal surgery
Radiotherapy
Bromocriptine to block excess prolactin
Somatostatin analogues to block GH

73
Q

Adverse effects of vincristine

A

Peripheral neuropathy
Paralytic ileus
Myelosuppression

74
Q

Adverse effects of docetaxel

A

Neutropenia

75
Q

Adverse effects of bleomycin

A

Lung fibrosis

76
Q

Adverse effects of cyclophosphamide

A

Haemorrhagic cystitis
Myelosuppression
TCC

77
Q

Adverse effects of cisplatin

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

78
Q

Risk factors for development of chemotherapy side effects

A

Anxiety
<50
Concurrent use of opioids
Type of chemo used

79
Q

Adverse effects of anthracyclines eg doxorubicin

A

Cardiomyopathy

80
Q

Describe imaging of glioblastoma

A

Solid tumour with central necrosis and a rim that enhances with contrast
Disruption of BBB - vasogenic oedema

81
Q

Describe meningioma

A

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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