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Focused 2 > Oncology > Flashcards

Oncology Flashcards

1
Q

What are 6 factors protective against colorectal cancer?

A
  1. NSAIDs
  2. aspirin
  3. folate
  4. magnesium
  5. diet high in fruit and vegetables, fibre and dairy products
  6. HRT
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2
Q

What are 10 risk factors associated with colorectal cancer?

A
  1. high fat diet
  2. red meat consumption
  3. diet low in fruit and vegetables
  4. smoking
  5. alcohol
  6. lack of physical activity
  7. family history
  8. hereditary conditions (FAP, HNPCC/Lynch)
  9. neoplastic polyps (villous + tubular adenomas)
  10. IBD
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3
Q

What are the 2 eponymous syndromes causing FAP?

A
  1. Gardner’s
  2. Turcot’s
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4
Q

What are the NICE ‘refer 2ww’ criteria for CRC (3 categories)?

A
  1. ≥40y with unexplained weight loss and abdominal pain
  2. ≥50y with unexplained rectal bleeding
  3. ≥60y with: IDA, CIBH, +ve FIT
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5
Q

What tumour markers are associated with pancreatic cancer?

A

CA 19-9 (9 looks like a pancreas)

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6
Q

What tumour markers are associated with breast cancer?

A

CA 15-3 (3 looks like breasts)

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7
Q

What tumour markers are associated with hepatocellular carcinoma?

A

AFP (alpha feto protein)

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8
Q

Which cancers are associated with S-100 tumour marker?

A

melanoma, schwannomas

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9
Q

What 3 cancers is tumour marker bombesin related to?

A
  1. small cell lung carcinoma
  2. gastric cancer
  3. neuroblastoma
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10
Q

What cancer are raised beta human chorionic gonadotrophin with raised AFP suggestive of?

A

non-seminomatous testicular cancer

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11
Q

What are 4 malignancies associated with EBV?

A
  1. nasopharyngeal carcinoma
  2. Burkitt’s lymphoma
  3. Hodgkin’s lymphoma
  4. HIV-associated central nervous system lymphomas

(non-malignant: hairy leukoplakia)

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12
Q

Which patient population has the highest risk of nasopharyngeal carcinoma?

A

South-East Asia - especially Chinese

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13
Q

What are 4 risk factors for nasopharyngeal carcinoma?

A
  1. EBV
  2. smoke
  3. chemical piollutants
  4. ingestion of salted fish
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14
Q

Where is the most common site for nasopharyngeal carcinoma?

A

lateral wall of naspharynx around ostium of Eustachian tube (fossa of Rosenmuller)

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15
Q

What age is affected by nasopharyngeal carcinoma?

A

bimodal - teens-20s and >50years

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16
Q

What are 6 possible symptoms of nasopharyngeal carcinoma?

A
  1. bilateral cervical node enlargement
  2. nasal voice
  3. epistaxis
  4. nasal obstruction
  5. deafness from Eustachian tube involvement
  6. cranial nerve involvement (from extension into skull base)
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17
Q

What is the radiological modality of choice to diagnose nasopharyngeal carcinoma?

A

MRI with gadolinium and fat suppression

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18
Q

What is the mainstay of nasopharyngeal carcinoma treatment?

A

external irradiation

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19
Q

What is the commonest primary neoplasm of the mediastinum?

A

thymoma

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20
Q

What is the thymus?

A

lymphoid organ behind sternum (in front of great vessels) - responsible for development of T lymphocytes in early life then involutes after puberty
composed predominantly of epithelial cells and lymphocytes

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21
Q

What is the rule of thirds for presentation of thymoma?

A
  1. one third: compressive symptoms (SVCO, dysphagia, cough, CP)
  2. one third: assoc autoimmune diorder e.g. myasthenia, pure red cell aplasia, Good’s syndrome
  3. one third: asymptomatic, incidental finding
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22
Q

What is Good’s syndrome?

A

thymoma + combined immunodeficiency + hypogammaglobulinaemia

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23
Q

What is the investigation of choice for thymoma?

A

CT to estimate size + extent, + biopsies with CT-guided needle

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24
Q

What is the treatment for thymoma?

A

surgery +- adjunctive chemo or radiotherapy

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25
Q

What are the 3 key metabolic abnormalities in tumour lysis syndrome?

A
  1. hyperkalaemia
  2. hyperphosphataemia
  3. hypocalcaemia
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26
Q

Which types of cancer are susceptible to tumour lysis syndrome?

A

Hodgkin’s lymphoma and leukaemia

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27
Q

What causes tumour lysis syndrome?

A

breakdown of tumour cells + subsequent release of chemicals from the cell - leads to high potassium and phosphate, low calcium

28
Q

What are the options for the prevention of tumour lysis syndrome?

A
  • IV fluids
  • rasburicase OR allopurinol
29
Q

Why is rasburicase used as prophylaxis (+ treatment) of tumour lysis syndrome?

A

= recombinant version of urate oxidase (enzyme that metabolises uric acid to allantoin). allantoin is more water-soluble than uric acid - more easily excreted by kidneys

30
Q

What is rasburicase vs allopurinol used for prophylaxis against tumour lysis syndrome?

A

rasburicase used for patients at higher risk; allopurinol for patients in lower risk groups

31
Q

What is the management of tumour lysis syndrome?

A

rasburicase OR allopurinol (don’t give together - reduces effect of rasburicase)

32
Q

What scoring system is used to grade tumour lysis syndrome?

A

Cairo-Bishop scoring system - laboratory tumour lysis syndrome vs clinical tumour lysis syndrome

33
Q

What is laboratory vs clinical tumour lysis syndrome?

A
  • laboratory: abnormality in 2 or more of the following, occuring within 3 days before or seven days after chemotherapy:
  • uric acid > 475umol/L or 25%
  • potassium >6 mmol/L or 25% increase
  • phosphate >1.125 mmol/L or 25%
  • calcium <1.75mmol/L or 25% decrease
  • clinical: laboratory plys one or more of:
  • increased serum creatinine (1.5x upper limit of normal)
  • cardiac arrhythmia or sudden death
  • seizure
34
Q

What is now the commonest type of oesophageal cancer?

A

adenocarcinoma (develops in patients with h/o GORD or Barrett’s)

35
Q
A
36
Q

Where are adenocarcinomas vs squamous cell carcinomas most commonly found?

A
  • adenocarcinomas - near GOJ
  • squamous cell carcinomas - upper 2/3 of oesopahgus
37
Q

What are 5 risk factors for oesphageal squamous cell cancer?

A
  1. smoking
  2. alcohol
  3. achalasia
  4. Plummer-Vinson syndrome
  5. diets rich in nitrosamines
38
Q

What are 4 risk factors for oesophageal adenocarcinoma?

A
  1. GORD
  2. Barrett’s
  3. smoking
  4. obesity
39
Q

What is the preferred investigation for locoregional staging of oesophageal cancer?

A

endoscopic ultrasound

40
Q

Which investigations are used for initial staging in oesophageal cancer?

A

CT TAP (FDG-PET CT to detect occult mets if not seen on initial staging CT scans)

41
Q

What are the treatment options for oesphageal cancer?

A
  • T1N0M0 - surgical resection (Ivor-Lewis oesophagectomy commonest)
  • Often adjuvant chemotherapy in addition
42
Q

What is the biggest surgical challenge in oesophageal cancer?

A

anastomotic leak - intrathoracic anastomosis results in mediastinitis

43
Q

What is the commonest cause of hepatocellular carcinoma?

A

chronic hepatitis C

44
Q

What is the commonest cause of hepatocellular carcinoma worldwide?

A

chronic hepatitis B

45
Q

Which 2 drugs are risk factors for hepatocellular carcinoma?

A
  1. COCP
  2. anabolic steroids
46
Q

What are 5 management options for hepatocellular carcinoma?

A
  1. surgical resection (early disease)
  2. liver transplantation
  3. radiofrequency ablation
  4. transarterial chemoembolisation
  5. sorafenib: multikinase inhibitor
47
Q

What is the commonest primary malignant bone tumour?

A

osteosarcoma

48
Q

Which 2 bone malignancies are seen in children and adolescents?

A
  1. osteosarcoma
  2. Ewing’s sarcoma
49
Q

Which type of cartilage / bone malignancy is seen in middle-aged adults?

A

chondrosarcoma

50
Q

What are the classic x-ray findings of osteosarcoma?

A
  • Codman triangle - from periosteal elevation
  • sunburst pattern
51
Q

Where does osteosarcoma most commonly occur in bones?

A

metaphyseal region of long bones prior to epiphyseal closure (40% in femur, 20% in tibia, 10% in humerus)

52
Q

What type of cells are involved in Ewing’s sarcoma?

A

small round blue cell tumour

53
Q

What type of gene mutation is seen in osteosarcoma?

A

Rb mutation (association with retinoblastoma)

54
Q

Which bones does Ewing’s sarcoma occur in most frequently?

A

pelvis and long bones

55
Q

What is seen on x-ray in Ewing’s sarcoma?

A

onion skin appearance

56
Q

What is the most common benign bone tumour?

A

osteochondroma (exotosis)

57
Q

What are 3 types of benign bone tumours?

A
  1. osteoma
  2. osteochondroma
  3. giant cell tumour
58
Q

What is seen on x-ray in giant cell tumour?

A

double bubble or soap bubble appearance

59
Q

What age group is affected by giant cell tumours?

A

20-40 years

60
Q

What age group is affected by osteochondromas?

A

< 20 years

61
Q

At what site do osteomas usually occur?

A

skull (Gardner’s syndrome - variant of FAP)

62
Q

What are 3 types of cancer that COCP is protective against?

A
  1. ovarian
  2. endometrial
  3. colorectal cancer
63
Q

What are 3 paraneoplastic syndromes associated with small cell lung carcinoma?

A
  1. ectopic ACTH production + ACTH-like subsance
  2. SIADH
  3. Lambert Eaton myasthenic syndrome
64
Q

What type of paraneoplastic syndrome is associated with squamous cell lung carcinoma?

A

PTHrP - parathyroid-related protein production

65
Q

At what age is peak incidence of a thymoma?

A

4th-5th decade of life

Focused 2 (27 decks)

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