Oncology

Question 1

Management of stages of NSCLC

Answer 1

Stage I and II - surgical resection
Stage II and III - adjuvant chemotherapy following resection
Stage III and IV - chemoradiotherapy if non-resectable

Question 2

Adverse effects - tamoxifen in breast cancer

Answer 2

Hot flushes
Thromboembolism
Endometrial cancer

Question 3

Adverse effects - aromatase inhibitors (eg. letrozole) in breast cancer

Answer 3

Osteoporosis and bone loss
Arthralgia
(Use in post-menopausal women only)

Question 4

Colorectal cancer - NHMRC screening guidelines for average risk

Answer 4

No history or family history of cancer OR 1 1st/2nd degree relative diagnosed age 55 or older

• FOBT 2 yearly for over age 50
• Sigmoidoscopy 5 yearly over age 50

Question 5

Colorectal cancer - NHMRC screening guidelines for moderate risk

Answer 5

2 1st degree relatives OR 1st degree relative diagnosed less than age 50

• Colonoscopy 5 yearly from age 50 or 10 years prior to family member diagnosis age
• Flexi-sigmoidoscopy and barium enema, if unable to do colonoscopy

Question 6

Colorectal cancer - NHMRC screening guidelines for high risk

Answer 6

Confirmed FAP - Sigmoidoscopy yearly from age 15 til development of polyposis

HNPCC - Colonoscopy 1-2 yearly from age 25 or 5 years prior to family member diagnosis age

Question 7

Hereditary non-polyposis colon cancer (HNPCC) - clinical features

Answer 7

Age less than 50
Proximal (Right sided colon predominantly)
Microsatellite instability
Poorly differentiated
Mucinous
Lymphocytic infiltrate

Question 8

Extravasation injury - vesicants (potential to cause tissue necrosis)

Answer 8

Anthracyclines (eg. doxorubicin - most significant)
Vinca alkaloids (eg. vincristine)

Question 9

Extravasation injury - irritants (inflammatory reaction at site)

Answer 9

Platinum analogues (eg. cisplatin)
Taxanes (eg. paclitaxel)

Question 10

Cancer associated with Streptococcus bovis

Answer 10

Colorectal cancer

Question 11

Chemotherapy adverse effects - cardiotoxicity

Answer 11

Anthracycline (doxorubicin)

• arrhythmias, myocardial necrosis, vaso-occlusion or vasospasm - dose dependent, reversible on cessation
• cardiac failure - dose dependent, irreversible

5-Fluorouracil
- coronary vasospasm

Question 12

Chemotherapy adverse effects - neuropathy

Answer 12

Vincristine
Oxaliplatin
Taxol
Cisplatin/carboplatin
Bortezomib
TNF alpha blockers

Question 13

Chemotherapy adverse effects - infertility

Answer 13

Permanent
- Cyclophosphamide

Reversible

• Doxorubicin
• 5-fluorouracil
• Taxanes

Question 14

Tumour markers - AFP

Answer 14

Nonseminomatous germ cell tumour

Hepatocellular carcinoma

Question 15

Tumour markers - B-HCG

Answer 15

Testicular germ cell tumour (elevation more than 10000 IU/L)

Question 16

Tumour markers - Ca 15-3

Answer 16

Breast cancer (metastatic)

Question 17

Tumour markers - Ca 19-9

Answer 17

Pancreatic cancer
Gall bladder cancer
Cholangiocarcinoma

Question 18

Tumour markers - Ca 125

Answer 18

Ovarian cancer

Endometrial cancer

Question 19

Tumour markers - CEA

Answer 19

Colorectal cancer
Breast cancer (metastatic)
Smoking

Question 20

Paraneoplastic antibodies - anti-Hu

ANNA-1, anti neuronal nuclear Ab

Answer 20

• SCLC

Encephalomyelitis, cerebellar degeneration, sensory neuropathy, autonomic dysfunction

Question 21

Paraneoplastic antibodies - anti-Yo

PCA-1, Purkinje cell Ab

Answer 21

• Ovarian
• Breast

(Cerebellar degeneration)

Question 22

Paraneoplastic antibodies - anti-Ri

ANNA-2, anti neuronal nuclear Ab 2

Answer 22

• Breast
• Ovarian
• SCLC

(Cerebellar degeneration, myoclonus, brainstem encephalitis)

Question 23

Paraneoplastic antibodies - anti-Tr

Answer 23

• Hodgkin lymphoma

Cerebellar degeneration

Question 24

Multiple endocrine neoplasia 1 (MEN1) - presentation

Answer 24

Parathyroid tumours
Pituitary adenomas
Pancreatic islet cell tumours

(“3 Ps”, due to MEN1 gene)

Question 25

Multiple endocrine neoplasia 2 (MEN2) - presentation

Answer 25

Medullary thyroid carcinoma Phaeochromocytoma - MEN2A - w/ primary hyperparathyroidism - MEN2B - w/ mucosal neuroma, intestinal ganglioneuroma, Marfanoid (due to RET gene)