Oncology Flashcards
ca125
ovarian cancer
ca19-9
pancreatic cancer
ca15-3
breast cancer
AFP
Hepatocellular cancer, teratoma
CEA
colorectal cancer
s-100
Melanoma, schwannomas
bombesin
Small cell lung carcinoma, gastric cancer, neuroblastoma
raised AFP excludes what
seminomas
features of gardner’s syndrome
- Autosomal dominant familial colorectal polyposis
- Multiple colonic polyps
- Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
- Desmoid tumours are seen in 15%
- Mutation of APC gene Chr5
- Patients undergo colectomy to reduce risk of colorectal cancer
- Variant of familial adenomatous polyposis coli
Features of Li-Fraumeni Syndrome
- Autosomal dominant
- Germline mutations to p53 tumour suppressor gene
- High incidence of malignancies particularly sarcomas and leukaemias
Diagnosed when: pt < 45, and first degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age
features of BRCA 1 and 2
- Chr 17 (BRCA 1) and Chr 13 (BRCA 2)
- Linked to breast cancer (60%) risk.
- Risk of developing ovarian cancer (55% with BRCA 1 and 25% with BRCA 2).
- BRCA2 mutation is associated with prostate cancer in men
Features of Lynch syndrome (HNPCC)
- Autosomal dominant
- Develop colonic cancer and endometrial cancer at young age
- 80% of affected individuals will get colonic and/ or endometrial cancer
- High risk individuals may be identified using the Amsterdam criteria
What is the amsterdam criteria
- 3 or more family members with a diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
- Two successive affected generations.
- One or more colon cancers diagnosed under age 50 years.
- Familial adenomatous polyposis (FAP) has been excluded.
How does a PET scan work
shows glucose uptake (cancer more metabolically active = use more glucose)
use of bleomycin
cytotoxic drug against lymphoma, metastatic germ cell cancer, squamous cell carcinoma and in some regimes non-Hodgkin’s lymphoma
adverse effect of bleomycin
pulmonary fibrosis
use of Cyclophosphamide
against lymphoma
adverse effect of Cyclophosphamide
- haemorrhagic cystitis
- myelosuppression
- transitional cell carcinoma
use of Anthracyclines (e.g. doxorubicin)
against lymphoma
adverse effects of Anthracyclines (e.g. doxorubicin)
cardiomyopathy (heart failure)
use of Docetaxel
against breast and lung cancer
adverse effect of Docetaxel
neutropenia
adverse effect of vincristine
peripheral neuropathy
what is vincristine used against
lymphoma
adverse effects of methotrexate
- Myelosuppression
- mucositis
- liver fibrosis
- lung fibrosis
adverse effect of cisplatin
- Nephrotoxicity (the primary dose-limiting side effect)
- Ototoxicity
- peripheral neuropathy
- hypomagnesaemia
cisplatin not used for lymphoma
common cause of lytic bone metastases in women
- most common= breast cancer
- 2nd most common= lung cancer
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
most common sites of metastases (descending order)
spine
pelvis
ribs
skull
long bones
Other than bone pain, features of metastases include:
pathological fractures
hypercalcaemia
raised ALP
most common cause of superior vena cava obstruction
lung cancer (small cell lung cancer, especially in the right upper lobe)
features of SVCO
- dyspnoea MC
- swelling of the face, neck and arms: conjunctival and periorbital oedema may be seen
- headache: worse in the mornings
- visual disturbance
- pulseless jugular venous distension
- stridor
mx of SVCO
EMERGENCY
- dexamethasone
- endovascular stenting provides symptom relief
- certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
HPV assoc with cervical cancer
16 + 18
HPV assoc with genital warts
6 + 11
tumour marker in medullary thyroid cancer
calcitonin
(MT originates from the parafollicular cells, which produce calcitonin)
lung cancer that has the strongest association with smoking
squamous cell lung cancer
features of squamous cell lung cancer
- SMOKING
- Central near large airways
- M > F
- associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia
- strongly associated with finger clubbing
- cavitating lesions are more common than other types
- hypertrophic pulmonary osteoarthropathy (HPOA)
features of adenocarcinoma of the lung
- peripheral
- women
- MC type in non smoking although majority that develop do smoke
features of small cell lung cancer
- near large airways
features of large cell lung cancer
- typically peripheral
- anaplastic, poorly differentiated tumours with a poor prognosis
- may secrete β-hCG
what is Kartagener’s syndrome
situs invertus + immotile cilia syndrome
which condition is thyroid medullary carcinoma associated with
Multiple endocrine neoplasia type II
organisms causing neutropenic sepsis
staph aureus
enterococcus
streptococcus
e-coli
Mx of neutropenic sepsis
Immediate assessment and vigorous resuscitation
Blood cultures
Septic screen
Empirical antibiotics urgently
Discuss with oncology re GCSF
Abx for neutropenic sepsis
1st: piperacillin/tazobactam + amikacin
if penicillin allergy: meropenem
how to prevent neutropenic sepsis
- reduce chemo dose
- prophylactic GCSF
- prophylactic abx
Mx of metastatic cord compression
high dose dexamethasone
MRI spine
surgical decompression
radiotherapy
causes of hypercalcaemia of malignancy
- 80% tumour production PTHrP
- 20% Osteolytic bone mets
- 1% ectopic PTH secretion, Vit D secreting lymphomas
presentation of of hypercalcaemia of malignancy
- Fatigue
- Anorexia
- muscle weakness
- Nausea
- abdo pain
- Constipation
- confusion
Mx of hypercalcaemia of malignancy
- rehydration
- stop thiazides and Ca supplements
- bisphosphonates
side effects of bisphosphonates
common
- Transient flu like syndrome with aches, fevers and chills.
- Bone and joint pain
- Nausea
- Electrolyte imbalance
Rare
- Osteonecrosis of the jaw (advise patients about dental work)
- Acute renal failure
what is tumour lysis syndrome
group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumour cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.
features of TLS
↑ PO4
↑K
↓Ca2+
↑Urate
Acidosis
Resulting in AKI/potential for cardiac arrhythmias/seizures
Mx of TLS
- Fluids
- ↑ PO4 - Phosphate binder, furosemide, mannitol
- ↑K - Insulin/glucose, Ca gluconate
- ↓Ca2+ - Correct phosphate
- ↑Urate - Allopurinol or rasburicase
- Early discussion regarding dialysis/renal replacement therapy
Prevention of TLS
- Prophylactic treatment – e.g. allopurinol/rasburicase (test for 6GPD deficiency)
- Hydration
- Monitor electrolytes
most likely route of tumour spread from lung to liver
through bloodstream
commonest lymphoproliferative neoplasm causing a lymphocytosis in over 65s
leukaemia
presentation of CLL
- 70s
- lymphocytosis
- normal Hb
- normal neutrophil count
- normal platelets
- small mature lymphocytes and smear cells are common
What condition are patients at higher risk of developing due to chemotherapy
gout (high urate)
glandular cell cancer
adenocarcinoma
keratin pearl cancer
SCC
