Oncology 4

Question 1

When use radiation therapy in breast cancer?

5Is of radiation

Answer 1

lumpectomy in DCIS and Stage 1 disease
Inflammatory breast cancer
lymph node Axillary positive
Inadequate resection - positive margins
liquidate to prevent recurrence post mastectomy

Question 2

If ovarian cancer - resistant to platinum based therapy what then?

Answer 2

After 6 months - TVS and CA125
Bevacizumab offers PS

IF Platinum resistant = Anthracycline/paclitaxel/Niraparib

IF Platinum sensitive = Continue platinum

Question 3

What is protective against endometrial cancer?

Answer 3

OCP pills!

Question 4

Which type of endometrial cancer is good and poor?

Answer 4

Good = endometrioid Adenocarcinoma ( estrogen dependent)

Bad = serous/clear cell ( estrogen independent)

Question 5

What features in cervical cancer a/w higher chance of relapse?

Answer 5

corpus luteum and LN involvement

Question 6

Localised cervical cancer - tx?

Mets cervical cancer - tx?

Answer 6

Brachytherapy + Cisplatin then after completion
-Cisplatin + Gemcitabine

Bevacizumab + Platinum + Topotecan - higher Survival
(BPT)

Question 7

Acute emesis - best tx?

delayed emesis - best tx?

Anticipatory emesis - best tx?

Answer 7

Acute emesis - ondasetron

delayed emesis - Dexamethasone

anticipatory emesis - benzodiazepines - lorazepam

Question 8

Why Ifosphamide causes encephalopathy?

Answer 8

Accumulation of chloracetaldehyde in CNS

Question 9

Ideal tumor marker criteria?

Answer 9

• Highly specific for tumor type
• Reflects accurately tumor progression/regression
• Long lead-time over clinical diagnosis
• short half-life - allows serial measurements
• Test to detect should be cheap and reliable

Question 10

What is Gating system in radiotherapy?

Answer 10

Detects motion - ie. breathing and only gives radiation when tumor is in the field

Question 11

OCP in ovarian cancer?

Answer 11

Reduce risk of Ovarian cancer

Question 12

Does benign prostatic hyperplasia has higher risk of prostate cancer?

Answer 12

NO

Question 13

Prevention of tumor lysis?

Answer 13

1.Aim urine output 2ml/kg/hour

2. NO URINARY ALKALINISATION
   - alkaline urine reduce Ca-Po4 solubility in urine so more in serum
   - Ca then bind like crazy to albumin bcoz more in serum so deposit in tissue -exacerbating the hypocalcemia

3.Drugs
Allopurinol - low risk of TLS
Febuxostat if renal dysfunction/allergic to allopurinol
Rasburicase - high risk of TLS / NO G6PD

Question 14

Has G6PD - what drugs needed to be avoided?

Answer 14

Oxidant drugs = primaquine/chloroquine
Sulfonamides abx
Nitrofurantoin
NSAIDS

Question 15

Cancer most associated with obesity?

Answer 15

Oesophageal adenocarcinoma - 1st

Pancreatic adenocarcinoma = 2nd

Question 16

Disadvantage of MRI biopsy compared with TRUS biopsy

Answer 16

TRUS biopsy - picks up more low grade tumours

Question 17

Therapy for Carboplatin-induced NV?

Answer 17

NK1 receptor antagonist - aprepitant
5HT3 antagonist - ondansetron
Dexamethasone

Question 18

NSCLC treatment?

Stage 1

Answer 18

Stage 1 (A if <3cm) = lobectomy and surveillance
-adjuvant radio and chemotherapy not recommended

Stage 2 = Platinum based chemotherapy

Question 19

IDH mutation found in what tumor and causes what?

Answer 19

AML
ALL
Glioma

-tumorigenesis

Question 19

IDH mutation found in what tumor and causes what?

Answer 19

AML
Glioma

-tumorigenesis

Question 20

Metastatic renal cancer - progressed even with sunitinib- what treatment?

Answer 20

Nivolumab + Cabozantinib

Question 21

Australia Cervical cancer screening new changes?

Answer 21

Screen age 25 - 75
Routine screening every 5 years ( 3 yrs if immunocompromised)
1st Cervical screening - 2 years from last Pap test
HPV-vaccinated women needs cervical screening as well

Question 22

Leptomeningeal carcinomatosis seen in what?

Dx it - choice of screening tool?

Answer 22

Metastatic disease infiltrating meninges - common in Breast/Lung/Melanoma and hematological malignancy
-presents with N+V/ seizures/neurological deficits

MRI brain and spine
CSF lumbar puncture AFTER MRI if not - leptomeningeal enchancement