Oncology Flashcards
What are Proto-oncogenes ??
They play an important physiological role in cellular growth & differentiation
- Oncogenes are derived from this
- ‘Gain of Func.” results in an increased risk of cancer; only 1 mutated copy is needed (a Dominant effect)
Through what processes do Proto-oncogenes become an Oncogene ??
Mutation (Point mutation)
Chromosomal translocation
Increased Protein Expression
Name cancers a/w EBV ??
Burkitt’s Lymphoma
Hodgkin’s Lymphoma
Post Transplant Lymphoma
Nasopharyngeal CA
Name the Cancers a/w Human Papilloma Virus 16/ 18 ??
Cervical cancer
Anal Cancer
Penile Cancer
Vulval Cancer
Oropharyngeal Cancer
Name the Cancers a/w the following viruses
- Human Herpes Virus 8
- HBV
- HCV
- Human T- Lymphotropic virus 1 (HTLV1)
- Kaposi’s Sarcoma
- HCC
- HCC
- Tropical Spastic Paraparesis & Adult T cell Leukaemia
What are Tumour Suppressor Genes ??
Genes which control the normal cell cycle
- Loss of func. leads to increased risk of cancer
- BOTH alleles must be mutated before Ca occurs
Examples of Tumour Suppressor Genes ??
- p53: Common to many Cancers, Li-Fraumeni synd.
- APC: Colorectal Cancer
- BRCA1 & BRCA2: Breast & Ovarian Ca ; In men increased risk of Breast & Prostate cancer
NF1: Neurofibromatosis
Rb: Retinoblastoma
WT1: Wilm’s tumour
Multiple Tumour Suppressor 1 (MTS-1, p16) : Melanoma
What is p53 ??
Tumour Suppressor Gene on Chr 17p
- MC mutated gene in Breast, Colon, Lung cancer
- Plays a crucial role in Cell cycle- preventing entry into S phase
- Key regulator of Apoptosis
What is Li-Fraumeni syndrome ??
- A D disorder
- Early onset of variety of cancers such as Sarcoma, Breast Ca, Leukaemias
- Caused by p53 mutation
Which brain tumours produce
- Late symptoms ??
- Early symptoms ??
- Rt. Temporal & Frontal lobe tumours reach considerable size before becoming symptomatic
- Tumours in the Speech & Visual areas, typically produce Early symptoms
Types of CNS tumours ??
Glioma & Metastatic disease (60%)
Meningioma (20%)
Pituitary lesions (10%)
Dx.- MRI scan
In Paediatrics: Medulloblastoma (Neuroendocrinal tumour) were the commonest; ASTROCYTOMA now accounts for the majority
Indications for Temporal Artery Biopsy ??
Superficial Temporal A is a terminal branch of External C A
Temporal Arteritis
- Age of onset > 50 yrs
- New onset Headache/ Localized Head pain
- Temporal artery tenderness on palpation or Reduced pulsation
- ESR > 50 mm/hr
Procedure of T A biopsy ??
- Position: Supine, Head 45 degrees
- USS doppler to locate the artery or Palpate
- Local Anaesthesia
- Artery within Temporoparietal fascia
- Clamp & Ligate the vessel
- Cut 3 to 5 cms
- Ligate the remaining ends with Absorbable suture
- Close the skin
Histopathology of Temporal artery biopsy in T Arteritis ??
Vessel wall Granulomatous arteritis with Mononuclear cell infiltrates & Giant cell formation
What is the CI for Temporal A Biopsy
& the risk involved with the procedure ??
- Glucocorticoid Therapy for > 30 days
- Injury to Facial & Auriculotemporal Nerve
Main frameworks used to tackle pts. who refuse Rx. ??
COMMON law: Used to treat pts. in Emergency scenarios
Mental CAPACITY Act (MCA)
- Used in pts. who require Rx. for physical disorders that affects brain func.
- Eg.- Delirium secondary to sepsis, Dementia
Mental HEALTH Act (MHA)
- Used in pts. with Mental disorder
- In pts. who are already admitted, a section 5(2) is used if this is not the time for more formal section 2 or 3
- Eg.- Pt. with mental disorder + Attempting to discharge themselves (when it is thought it may harm the pt.)
MC sites of Brain tumour in
- Adults ??
- Childhood ??
- Supratentorial
- Infratentorial
MC Metastatic brain tumours ??
MC form of Brain tumour
- Lung Cancer (most common)
- Breast
- Bowel
- Skin (Melanoma)
- Kidney
What is Glioblastoma multiforme ??
MC primary tumour in adults & is a/w poor prognosis (1 year)
- Solid tumour + Central necrosis & a rim that enhances with contrast
- Disruption of BBB => a/w Vasogenic Oedema
- HP: Pleomorphic tumour cells border necrotic areas
Rx: Sx + Post-Op. CT & RT
DEXAMETHASONE to treat Edema
What is Meningioma ??
2nd MC primary brain tumour in adults
- Benign, extrinsic tumours of CNS
- Origin: Arachnoid cap cells of meninges
- Site: Next to Dura; Falx cerebri, Superior sagittal sinus, Convexity or Skull base
- HP: Spindle cells in concentric whorls + Psammoma bodies-calcified
C/F - Compression symptoms rather than Invasion
Rx.- Observation, RT & Sx. resection
What is Vestibular Schwannoma ??
aka Acoustic Neuroma is a benign tumour arising from 8th CN
- Site: CP angle
- NF-2 is a/w B/L V S
- HP: Antoni A or B pattern is seen. Verocay bodies- Acellular areas surrounded by nuclear palisades
- C/F: D V T, SNHL, Facial N palsy, Corneal reflex absent
Rx.- Observation, RT, Sx.
MC primary brain tumour in Children ??
PILOCYTIC ASTROCYTOMA
- HP: Rosenthal fibres (Corkscrew Eosinophillic bundle)
What is Medulloblastoma ??
Aggressive paediatric brain tumour
- Site: Infratemporal compartment
- Spread: CSF system
- HP: Small, blue cells. Rosette pattern of cells with many mitotic figures
What is Ependymoma ??
Primary brain tumour which is a type of Glioma that starts from Ependymal cells
- Site: 4th ventricle
- May cause Hydrocephalus
- HP: Perivascular Pseudorosettes
Primary brain tumour which is a type of glioma (Glial cells)
- Benign, slow growing tumour
- Site: Frontal lobes
- HP: Calcifications with ‘Fried Egg” appearance
What is Haemangioblastoma ??
Vascular Benign tumour of the Cerebellum
- a/w Von Hippel-Lindau syndrome
- HP: Foam cells & High vascularity
Flying is CI in which CVS conditions ??
Unstable Angina
Uncontrolled HTN
Uncontrolled Cardiac Arrhythmia
Decompensated Heart disease
Severe symptomatic valvular disease
Relative CI for flying in CVS conditions ??
Uncomplicated MI: Can fly after 7 to 10 days
Coronary Artery Bypass graft : After 10 to 14 days
PCI : after 3 days
Stroke : Wait for 10 days following event, BUT if stable, may be carried out within 3 days of the event
Restrictions to flying in Resp. conditions ??
Pneumonia: Clinically improved with NO residual infection
Pneumothorax: Absolute CI;
- CAA suggests pts. may travel 2 wks. after successful drainage IF there is no residual air
- BTS: NOT to travel for 1 week post check x-ray
Conditions to fly in Pregnancy ??
Most airlines do not allow travel
- after 36 wks. in 1st pregnancy &
- after 32 wks. in multiple pregnancy
Most airlines require a certificate after 28 wks confirming that pregnancy is progressing normally
Conditions to fly after the following
- Abdominal Sx. ??
- Laparoscopic Sx. ??
- Colonoscopy ??
- Following Plaster Cast application ??
- Avoid for 10 days
- After 24 hrs
- After 24 hrs
- Restrict flying for 24 hrs on flights of < 2hrs (OR) 48 hrs for longer flights
Conditions to fly with Haematological disorders ??
Pts. with Hb > 8 g/dl may travel without problems (assuming there is no coexisting conditions such as CVS or Resp. diseases)
Drugs that should be avoided during Breast feeding ??
- Ciprofloxacin, Tetracyclines, Chloramphenicol, Sulfonamides
- Lithium, BZPs, Clozapine
- Aspirin
- Carbimazole
- MTX, Cytotoxic drugs
- Sulfonylureas
- Amiodarone
Drugs that are safe while Breast feeding ??
- Penicillins, Cephalosporins, Trimethoprim
- Glucocorticoids (avoid high doses), Levothyroxine
- Na Valproate, Carbamazepine
- Salbutamol, Theophyllines
- TCAs Antipsychotics (avoid Clozapine)
- Beta-blockers, Hydralazine
- Warfarin, Heparin
- Digoxin
Major CI for Breast feeding ??
- Galactosaemia
- Viral Infections (Controversial with respect to HIV in the developing world)
