Oncology Flashcards
Common sites of metastasis for Melanoma (and prognosis)
Skin, Lungs, Liver, Brain
Skin favourable
Lung moderate
Any other visceral organ poor
What form of sun exposure carrier highest risk for Melanoma?
Intermittent (higher risk than prolonged)
What is Superficial Spreading Melanoma?
- Most common type, 70% of cases
- Lesions spread in radial fashion and can be treated curatively with surgical excision
What are the key features of Acral Melanoma?
Lesions occur on palms, soles, nailbeds and are not linked to UV exposure. Extremely poor prognosis with limited response to treatment. Typically don’t have BRAF mutations
What is the most aggressive form of Melanoma?
Nodular Melanoma. Grows in vertical fashion and thus metastasises early. 10% of cases, 50% of deaths. Lesions elevated, not linked to sun exposure.
Stage I Melanoma features and management
0-1mm with or without ulceration, 1-2mm without ulceration.
Can be managed with complete excision alone.
Key poor prognostic markers for Melanoma
Increasing Breslow Depth
Presence of Ulceration
Stage II Melanoma features and management
Thicker tumours than Stage I, but without lymphatic spread or distant mets.
Complete excision required, plus sentinel lymph node biopsy and screening for distant mets. Screening for BRAF mutations should be completed.
Stage III Melanoma features and management
Sentinel Lymph Node Biopsy positive disease, without more distant metastasis.
lymph node dissection reduces morbidity but not mortality.
No role for chemotherapy
Emerging evidence for targeted therapy and immunotherapy in IIIb-IIIc disease.
When is surgical resection appropriate for metastatic melanoma (other than for primary lesion)?
Evidence for surgical resection if there is a single metastatic deposit and local control of the initial lesion has been achieved
When is Immunotherapy indicated (PBS Subsidised) for Melanoma?
BRAF negative disease, progression on targeted therapy
What is a key side effect of BRAF Inhibitors?
Increased SCC and BCC risk
What are the benefits of using MEK inhibitors with BRAF Inhibitors?
MEK proteins are a key downstream oncogene which increases in activity if BRAF therapy used alone. Increase PFS and OS over BRAF monotherapy.
Also reduce risk of BCC and SCC (but increase frequency of fevers)
Most common malignant skin tumour?
BCC
What form of skin cancer may develop in a chronic wound/ulcer?
Marjolin Ulcer - subtype of SCC
When is Radiotherapy indicated for BCC and SCC?
For unresectable primary lesions
What specific class of systemic therapy may be indicated in locally advanced or metastatic BCC?
Hedgehog Pathway Inhibitors: Vismodegib, Sonidegib
What mutation is common in non smoking Asian women with lung cancer?
EGFR
What is the median survival for metastatic lung cancer without active systemic therapy (i.e. best supportive care)?
4-5 months
Which lung cancer subtype is strongly associated with hypercalcaemia of malignancy?
Squamous
What population factors are markers of poor prognosis in Lung Cancer?
Patients from regional/rural areas, Indigenous patients
Follow up post screening colonoscopy
No adenomas: 10 years
1-2 adenomas and all <10mm, no villous features, no high grade dysplasia: 5 years
3-4 adenomas OR any adenoma >10mm, villous features or high grade dysplasia: 3 years
>/=5 polyps: 5-9 1 year; 10 or more <1 year
Possible incomplete or piecemeal excision of large/sessile adenoma: 3-6 months
Screening for patients with FAP
Annual colonoscopy from age 12 until collectors performed
Endoscopy from age 20 (for duodenal cancer - 100% lifetime risk)
Indications for complete colectomy:
- diffuse polyposis (>100)
- multiple polyps >10mm
- severe dysplasia within polyps
- Malignancy
MUTYH Associated Polyposis
1% of colorectal cancer
15% of patients with multiple adenomas and negative APC gene mutation testing
AR inheritance
Usually repairs oxidative DNA damage
Increased CRC risk
Does not cause desmoid tumour formation
2 yearly scope from age 30
