oncology

Question 1

MEN1

Answer 1

anterior pituitary
parathyroid
pancreatic

Question 2

tumour suppressor genes

Answer 2

act recessively - need 2 copies to be altered to stop normal function
2 hit hypothesis

Question 3

adenocarcinoma lung

Answer 3

female asian non smoker
EGFR mutation - gefitinib, erlotinib
EML4ALK mutation - crizotinib TKI

Question 4

Li Fraumeni

Answer 4

p53

breast cancer

Question 5

Cowden

Answer 5

PTEN

breast cancer, skin

Question 6

MEN2

Answer 6

ret oncogene

Question 7

Breast Cancer

Answer 7

HER2 trastuzumab for 12/12 with chemotherapy as trastuzumab is internalised by her2 positive cells; thus delivering chemotherapy to where it is needed
ER / PR tamoxifen / AIs for 5-10 years post chemotherapy

Question 8

Melanoma

Answer 8

test for BRAF mutation - vemurafenib
CTLA4 regulates immune system
use ipilimumab to potentiate the (CTLA4 Ig) interaction between APC and T cell for ongoing immune stimulation
PDI is between T cell and tumour
adalimumab is CTLA4 blocker which stops immune activation from occurring

Question 9

testicular CA

Answer 9

germ cell tumours - aFP, bHCG, LDH
seminoma - bHCG in 25%
non seminoma - bHCG, aFP in 85%

Question 10

young female non smoker Asian with adenocarcinoma lung

Answer 10

33% EGFR mutation - k ras wild type will respond to EGFR inhibitors
25% ALK mutation - crizotinib

Question 11

lung cancer surgical fitness

Answer 11

FEV1 > 2L will tolerate pneumonectomy
FEV1 > 1.5L will tolerate lobectomy
contraindications: CO2 > 45; DLCO < 40%, severe pul HT, AMI past 3/12

Question 12

VEGF

Answer 12

sunitinib, sorafenib in renal cancer

bevacizumab improves progression free survival in relapsed ovarian cancer

Question 13

pancreatic cancer

Answer 13

most in peutz jegher; BRCA2, HNPCC, FAP, Li Fraumeni

Question 14

germ cell tumours

Answer 14

seminomas - 15% HCG elevated; radiation, BEP

non seminomas - aFP, bHCG; BEP or surveillance