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Medicine > Oncology > Flashcards

Oncology Flashcards

1
Q

What is radiotherapy?

A

A treatment method that uses high-energy radiation to kill or damage cancer cells.

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2
Q

How does radiotherapy work to treat cancer?

A

It damages the DNA within cancer cells, preventing them from growing and dividing.

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3
Q

What are the two main types of radiotherapy?

A
  • External beam radiotherapy (EBRT)
  • Brachytherapy
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4
Q

What is external beam radiotherapy (EBRT)?

A

Delivers radiation from an external source to the tumour site, typically using a linear accelerator.

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5
Q

What is brachytherapy?

A

Involves placing radioactive material directly inside or near the tumour.

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6
Q

What is the advantage of brachytherapy?

A

Allows for high-dose radiation delivery to the tumour while minimising exposure to surrounding healthy tissue.

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7
Q

What is 3D Conformal Radiotherapy (3DCRT)?

A

A technique that uses three-dimensional imaging to shape radiation beams to match the tumour’s shape.

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8
Q

What are the advantages of 3D Conformal Radiotherapy (3DCRT)?

A
  • More precise targeting of the tumour
  • Minimises exposure to healthy tissues
  • Reduces side effects
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9
Q

What is Intensity-Modulated Radiotherapy (IMRT)?

A

A type of EBRT that modulates the intensity of radiation beams to conform to the tumour shape.

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10
Q

How does IMRT improve treatment precision?

A

Delivers radiation from multiple angles with varying intensity, allowing higher doses to the tumour while sparing healthy tissues.

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11
Q

What role does Image-Guided Radiotherapy (IGRT) play?

A

Enhances treatment accuracy by using imaging technologies to ensure precise targeting of the tumour.

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12
Q

How does Stereotactic Radiosurgery (SRS) differ from conventional radiotherapy?

A

Delivers high doses of radiation with sub-millimetre precision in one or a few sessions.

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13
Q

What type of tumors is SRS typically used for?

A

Small, well-defined tumors, such as those in the brain.

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14
Q

What is proton therapy?

A

A radiotherapy technique that uses protons instead of X-rays.

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15
Q

What is the Bragg peak in proton therapy?

A

A unique property where protons deliver the maximum dose at a specific depth, reducing exposure to healthy tissues.

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16
Q

What steps are involved in the treatment planning process for radiotherapy?

A
  • Imaging
  • Target Volume Definition
  • Dose Calculation
  • Simulation
  • Delivery
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17
Q

What is Planning Target Volume (PTV)?

A

Includes the Clinical Target Volume (CTV) and an additional margin for tumor movement and positioning variations.

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18
Q

How does adaptive radiotherapy differ from standard radiotherapy?

A

Adjusts the treatment plan based on changes in the tumour and patient anatomy during treatment.

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19
Q

What are the benefits of adaptive radiotherapy?

A
  • More precise targeting
  • Reduces side effects
  • Improves treatment effectiveness
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20
Q

For which types of cancer is brachytherapy commonly used?

A
  • Prostate cancer
  • Cervical cancer
  • Breast cancer
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21
Q

What is the purpose of palliative radiotherapy?

A

To alleviate pain and improve the quality of life in advanced cancer patients.

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22
Q

What role do fiducial markers play in radiotherapy?

A

Help guide and verify the precise targeting of radiation beams.

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23
Q

What is the function of Cone Beam CT (CBCT) in radiotherapy?

A

Provides real-time, 3D imaging for precise positioning and verification.

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24
Q

How is radiotherapy tailored for patients with low performance status?

A

Palliative and short-course radiotherapy regimens are used to minimize treatment burden.

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25
Q

What factors influence the choice of radiotherapy technique?

A
  • Type and stage of cancer
  • Tumor location and size
  • Patient health status
  • Previous treatments
  • Patient preferences
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26
Q

What are common acute side effects of radiotherapy?

A
  • Skin irritation
  • Fatigue
  • Nausea
  • Localised pain
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27
Q

What are common long-term side effects of radiotherapy?

A
  • Fibrosis
  • Secondary cancers
  • Organ-specific issues
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28
Q

How do radiotherapy teams minimize radiation exposure to healthy tissues?

A

Use advanced imaging, precise treatment planning, and techniques like IMRT and IGRT.

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29
Q

What are some emerging trends in radiotherapy?

A
  • Proton therapy
  • Adaptive radiotherapy
  • Integration of artificial intelligence
  • Novel imaging techniques
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30
Q

What are potential benefits of integrating artificial intelligence in radiotherapy?

A
  • Improved treatment accuracy
  • More personalised treatment.
  • Enhanced decision-making
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31
Q

What are challenges of integrating artificial intelligence in radiotherapy?

A
  • Data privacy concerns
  • Need for extensive validation
  • Integration into existing workflows
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32
Q

What are resection margins, and why are they important in surgical excision of a tumour or lesion?

A

Resection margins refer to the edges or borders of the tissue removed during the surgical excision of a tumour or lesion. They are crucial because they help determine whether the entire tumour has been removed or if residual cancerous or diseased cells remain.

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33
Q

How does the status of resection margins influence the likelihood of local recurrence?

A

The status of resection margins influences the likelihood of local recurrence because clear or negative margins indicate that the tumour has likely been completely removed, reducing the risk of recurrence. Positive margins suggest that some tumour cells may still be present, increasing the risk of recurrence.

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34
Q

What is the difference between negative (clear) margins and positive (involved) margins?

A

Negative (clear) margins mean no tumour cells are present at the edges of the removed tissue, indicating that the resection likely encompassed all the tumour cells. Positive (involved) margins mean tumour cells are present at or very close to the edge of the tissue, suggesting that cancerous tissue may still be in the body and may require further treatment.

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35
Q

What are close margins, and why might they be concerning?

A

Close margins mean tumour cells are close to, but not at, the edge of the resected tissue. This can be concerning because it might indicate a higher risk of recurrence and may prompt further treatment depending on the tumour type and clinical scenario.

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36
Q

Why is achieving negative margins particularly important in breast cancer surgery?

A

Achieving negative margins in breast cancer surgery is important to reduce the risk of recurrence. The margin size requirements may vary based on whether breast-conserving surgery or mastectomy was performed.

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37
Q

How do margin requirements differ between colorectal cancer and soft tissue sarcomas?

A

For colorectal cancer, negative radial margins are critical to lower recurrence risks. In soft tissue sarcomas, a 2-cm margin is generally recommended to reduce recurrence.

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38
Q

What is the purpose of intraoperative pathology (frozen section) in assessing resection margins?

A

Intraoperative pathology (frozen section) is used during surgery to quickly assess margins. If margins are positive, the surgeon may immediately resect additional tissue to achieve negative margins.

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39
Q

How does permanent pathology (final margin assessment) contribute to post-surgical treatment planning?

A

Permanent pathology (final margin assessment) involves a thorough microscopic examination of the resected specimen after surgery to confirm the margin status. This helps guide post-surgical treatment planning.

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40
Q

What are the typical margin size requirements for breast cancer and colorectal cancer?

A

For breast cancer, typically, no tumour cells should be on the inked margin surface. For colorectal cancer, margins of at least 5 cm are usually recommended to reduce recurrence.

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41
Q

Why might the required distance for a “clear” margin vary based on tumour type and location?

A

The required distance for a “clear” margin varies based on tumour type and location because different cancers have different patterns of spread and recurrence risks.

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42
Q

How do positive margins affect the need for additional treatments such as chemotherapy or radiation therapy?

A

Positive margins often necessitate additional treatments such as chemotherapy or radiation therapy to reduce the likelihood of recurrence.

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43
Q

Why is margin status considered a strong prognostic indicator?

A

Margin status is considered a strong prognostic indicator because it provides information about the completeness of tumour removal and the potential need for further treatment.

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44
Q

What is the most common type of prostate cancer, and from which cells does it originate?

A

he most common type of prostate cancer is adenocarcinoma, which originates from the gland cells that produce prostate fluid.

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45
Q

How do adenocarcinomas vary in their aggressiveness?

A

Adenocarcinomas can vary in their aggressiveness, with some growing very slowly and others more rapidly.

46
Q

What type of prostate cancer originates from neuroendocrine cells and is known for its aggressive nature?

A

Small cell carcinoma originates from neuroendocrine cells and is known for its aggressive nature.

47
Q

Why might small cell carcinoma not elevate PSA levels?

A

Small cell carcinoma might not elevate PSA levels because it behaves differently from typical prostate adenocarcinomas and does not produce PSA in significant amounts.

48
Q

Where does transitional cell carcinoma typically start, and how does it spread to the prostate?

A

Transitional cell carcinoma typically starts in the bladder and spreads to the prostate.

49
Q

Why is transitional cell carcinoma considered less common and more challenging to treat?

A

Transitional cell carcinoma is considered less common and more challenging to treat due to its origin in the bladder and its spread pattern, which can complicate treatment strategies.

50
Q

What are the two types of neuroendocrine tumors mentioned, and how do they differ in terms of cell origin?

A

The two types of neuroendocrine tumors mentioned are small cell and large cell neuroendocrine carcinomas. They differ in terms of cell origin, with both arising from neuroendocrine cells but exhibiting different cellular characteristics.

51
Q

What makes neuroendocrine tumors particularly aggressive?

A

Neuroendocrine tumors are particularly aggressive due to their rapid growth and tendency to spread quickly.

52
Q

From which tissues do sarcomas originate in the prostate?

A

Sarcomas originate from the connective tissues of the prostate.

53
Q

Why might sarcomas require different treatment strategies compared to adenocarcinomas?

A

Sarcomas might require different treatment strategies compared to adenocarcinomas because they arise from different tissue types and often exhibit more aggressive behavior.

54
Q

What are the two initial assessments recommended by NICE for suspected prostate cancer?

A

The two initial assessments recommended by NICE are the Digital Rectal Examination (DRE) and the Prostate-Specific Antigen (PSA) test.

55
Q

What imaging technique does NICE recommend as the first-line investigation for suspected clinically localised prostate cancer?

A

NICE recommends multiparametric MRI (mpMRI) as the first-line investigation for suspected clinically localised prostate cancer.

56
Q

What type of biopsy is recommended if mpMRI results suggest the presence of cancer?

A

If mpMRI results suggest the presence of cancer, an MRI-targeted biopsy is recommended.

57
Q

How are prostate cancer patients categorised into risk groups according to NICE guidelines?

A

Patients are categorised into risk groups (low, intermediate, high) based on:

PSA levels
Gleason score
The extent of cancer spread.

58
Q

What scans are recommended for patients with high-risk or locally advanced prostate cancer to check for cancer spread?

A

For patients with high-risk or locally advanced prostate cancer, CT scans and bone scans are recommended to check for the spread of cancer to other parts of the body.

59
Q

In what cases might genetic testing be recommended according to NICE guidelines?

A

Genetic testing may be recommended in certain cases to identify specific mutations that could influence treatment options and prognosis.

60
Q

What does NICE emphasise regarding patient information and support?

A

NICE emphasises the importance of providing patients with clear, tailored information about their diagnosis and treatment options, along with decision aids and support from healthcare professionals to help patients make informed choices.

61
Q

Name two performance status systems used in cancer patients.

A

ECOG (Eastern Cooperative Oncology Group)
Karnofsky

62
Q

What cancers typically cause SVC syndrome?

A

Lung cancers.
Non-Hodgkin lymphoma is another potential cause.

63
Q

Neutropenic sepsis typically occurs when the neutrophils count drops below ___________.

A

0.5*10^9/L

64
Q

Risk factors for developing hepatocellular carcinoma.

A

Aflatoxins
Pyrrolizidines
Hepatitis (80% of cases globally)
Iron overload
Type 2 DM
NASH
Alpha-1-antitrypsin deficiency
Wilson’s disease
Haemophilia

65
Q

Most common subtype of malignant melanoma.

A

Superficial spreading melanoma (60-70% of cases).

66
Q

Suggest an important prognostic indicator in melanoma.

A

Breslow’s thickness.

67
Q

What is the underlying pathophysiology of LEMS?

A

Autoantibodies against presynaptic voltage-gated calcium channels. These calcium channels are crucial for acetylcholine release.

68
Q

Neutropenic sepsis drug of choice.

A

Piperacillin/tazobactam (Tazocin)

69
Q

ECOG

A
  • 0: Fully active, able to carry on all pre-disease performance without restriction.
  • 1: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature.
  • 2: Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours.
  • 3: Capable of only limited self-care; confined to bed or chair more than 50% of waking hours.
  • 4: Completely disabled; cannot carry on any self-care; totally confined to bed or chair.
  • 5: Dead.
70
Q

Over 43,000 new lung cancers are diagnosed each year in the UK. A full time GP is likely to diagnose approximately one person with lung cancer each year. The 5-year survival is below __________.

A

10%

71
Q

Test for SVC syndrome.

A

Pemberton test.

72
Q

Where else can mesotheliomas arise, other than in the lungs?

A

Peritoneum.

Less commonly:
Pericardium
Tunica vaginalis

73
Q

What imaging modality is most appropriate when initially investigating for mesothelioma?

A

Plain chest X-ray.

74
Q

Complete: Mesothelioma is seen in both sexes, though currently _____ of new mesotheliomas occur in males.

A

85%

75
Q

A chest X-ray suggests mesothelioma. What is the best course of action?

A

2-week-wait referral. Urgent.

76
Q

Most common primary malignant brain tumour in adults.

A

Glioblastoma multiforme.

77
Q

Most common primary brain tumour overall.

A

Meningioma.

78
Q

Single ring-enhancing lesion in a patient with AIDs. What type of malignancy is this likely to be?

A

Primary CNS lymphoma.

79
Q

What is the primary function of the mesothelium in the body?

A

The mesothelium acts as a protective barrier and provides a lubricated surface to reduce friction between moving organs and tissues.

80
Q

Suggest chemotherapeutic agents that can be used in the treatment of mesothelioma.

A

Pemetrexed+cisplatin (or carboplatin).
Pemetrexed+cisplatin trade name=Alimta.

81
Q

Alkylating agent mechanism of action.

A

Bifunctional Alkylation: The drug forms an irreversible bond between two base pairs in the DNA chain, causing cytotoxic effects that can destroy or poison the cell.

Monofunctional Alkylation: The drug reacts with just one strand of a base pair, separating it from its partner and eventually causing it and its attached sugar to break away from the DNA molecule

82
Q

Tumour marker for HPV-associated cancer.

A

p16

83
Q

Bone metastases treatments.

A

NSAIDs.
Radiotherapy for pain.
Bisphosphonates.
Denosumab.

83
Q

Hypercalcaemia of malignancy causes.

A

Local osteolytic activity.
Elevated calcitriol.
Tumour secretes parathyroid hormone-related peptide.

84
Q

Denosumab mechanism of action.

A

Denosumab is a monoclonal antibody used to treat conditions associated with bone loss, such as osteoporosis, bone metastases, and certain cancers. Its mechanism of action involves targeting the RANK/RANKL pathway, which plays a critical role in bone remodeling and resorption.

85
Q

Calcium levels in hypercalcaemia.

A

Above 2.6 mmol/L.

86
Q

Serum corrected calcium.

A

Serum corrected calcium is a calculation that adjusts measured total calcium levels in the blood to account for the amount of calcium bound to albumin.

87
Q

Van Nuys Prognostic Index.

A

A numerical algorithm that helps predict the likelihood of a breast tumour recurring after the excision of ductal carcinoma in situ (DCIS).

88
Q

In someone with hypercalcaemia, which other electrolytes should you check?

A

Magnesium
Phosphate

89
Q

DCIS can be classified as stage ____ breast cancer.

A

0

90
Q

Primary tool for detecting DCIS.

A

Mammography

91
Q

For people having investigations for early and locally advanced invasive breast cancer:

A

> Perform pretreatment ultrasound evaluation of the axilla, and

> If abnormal lymph nodes are identified, perform ultrasound-guided needle sampling.

92
Q

Should genetic testing for BRCA1 and BRCA2 mutations be offered to women under 50 years with triple-negative breast cancer, including those with no family history of breast or ovarian cancer?

A

Yes.

93
Q

How is DCIS typically detected?

A

DCIS is often detected during a routine mammogram as part of breast cancer screening.

94
Q

What are the common symptoms of DCIS?

A

Common symptoms include a breast lump and bloody nipple discharge, although DCIS often causes no symptoms.

95
Q

What imaging technique is primarily used to diagnose DCIS?

A

Mammography is the primary imaging technique used to diagnose DCIS.

96
Q

What are microcalcifications, and how are they related to DCIS?

A

Microcalcifications are tiny specks of calcium in the breast tissue that can be seen on a mammogram and are often an early sign of DCIS.

97
Q

What additional diagnostic tests might be performed if a mammogram indicates an area of concern?

A

Additional diagnostic tests may include a breast ultrasound and a biopsy to further evaluate the area of concern.

98
Q

What is breast-conserving surgery (lumpectomy), and how is it used to treat DCIS?

A

Breast-conserving surgery (lumpectomy) involves removing the DCIS along with a small margin of surrounding healthy tissue. It is often followed by radiation therapy to eliminate any remaining cancer cells.

99
Q

When might a mastectomy be recommended for DCIS?

A

A mastectomy might be recommended if DCIS is widespread or if there are multiple areas of DCIS in the breast.

100
Q

How does radiation therapy help in the treatment of DCIS?

A

Radiation therapy helps to destroy any remaining cancer cells in the breast after a lumpectomy.

101
Q

Under what circumstances might hormone therapy be recommended for DCIS?

A

Hormone therapy might be recommended if the DCIS is hormone receptor-positive to reduce the risk of recurrence.

102
Q

What is the general prognosis for someone diagnosed with DCIS?

A

The prognosis for DCIS is generally excellent, especially when detected and treated early.

103
Q

Why is regular follow-up care important for patients treated for DCIS?

A

Regular follow-up care is important to monitor for any signs of recurrence and to ensure early detection if the cancer returns.

104
Q

MRI of the breast is not routinely used as part of the preoperative assessment in women with DCIS or invasive breast cancer. Give some situations when it could be considered.

A

> If the extent of disease is not clear from clinical examination, mammography and ultrasound assessment for planning treatment.

> If accurate mammographic assessment is difficult because of breast density.

> To assess the tumour size if breast-conserving surgery is being considered for invasive lobular cancer.

105
Q

Trastuzumab is used for which type of breast cancer?

A

HER2 receptor +

106
Q

In addition to breast cancer, trastuzumab can also be used to treat which cancer?

A

Gastric cancer.

107
Q

Mechanism of action of trastuzumab.

A

> Binding to HER2 receptors, blocking growth signals.

> Inhibiting cancer cell proliferation.

> Activating the immune system to destroy cancer cells through antibody-dependent cellular cytotoxicity (ADCC).

108
Q

A 30-year-old patient presents with an unexplained axillary lump. What are the potential causes, and what should be the next steps in evaluation and diagnosis?

A

Urgent Referral: The patient should be referred to a specialist to check for breast cancer within 2 weeks.

Clinical Examination: A thorough clinical examination should be conducted to assess the lump and any other associated symptoms.

Diagnostic Tests: Further diagnostic tests such as imaging (e.g., mammography or ultrasound) and possibly a biopsy may be recommended depending on the clinical findings.

109
Q

A 30-year-old patient presents with an unexplained breast lump, with or without pain. What type of referral does this presentation warrant?

A

Urgent (within 2 weeks).

110
Q
A

Medicine (26 decks)

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