Oncology Flashcards
What is the most common type of Hodgkin’s lymphoma?
Which type carries the best prognosis?
Which type carries the worst prognosis?
Which is associated with a large number of Reed-Sternberg cells?
Most common = Nodular sclerosing (associated with lacunar cells)
Best prognosis = Lymphocyte predominant
Worst prognosis = Lymphocyte depleted
Lots of RS cells = Mixed cellularity
Causes of SVC obstruction
Lung cancer, lymphoma, mediastinal mets
Effects of metastatic spinal cord compression (what happens acutely and chronically)?
What fraction have compression at >1 location?
Acute: direct compression–> oedema, venous congestion, demyelination
Prolonged–> vascular injury and infarction. Any meaningful recovery then unlikely.
1/5 have >1 location affected
Median survival of patients with brain metastases. What % of patients with cancer get them?
Standard treatment for palliation of brain mets
Role for chemo?
1-2 months. Up to 40%.
Standard palliative Rx = whole brain radiotherapy (?efficacy).
20Gy in 5x doses.
Other options might be resection, or stereotactic radiosurgery (‘gamma knife’) in future
Can use intrathecal chemo for haematological malignancies but not really others
VTE prophylaxis in malignancy
Generally LMWH.
Warfarin not good in ca as nutrition/liver function/drug interactions too unpredictable.
For patients needing long term care in remission, might consider warfarin or NOACs.
Symptoms of hypercalcaemia
Lethargy, confusion, anorexia, nausea, constipation, polyuria, polydipsia, bone aches
Performance status categories
0 - Fully active, able to carry on all pre-disease performance without restriction
1 - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2 - Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours
3 - Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours
4 - Completely disabled; cannot carry on any selfcare; totally confined to bed or chair
5 - Dead
Tumour markers for: Breast Pancreatic Ovarian Colorectal Prostate
CA 15-3 CA 19-9 CA 125 CEA PSA
What are the following tumour markers for?
S-100
AFP
Bombesin
Melanoma, schwannoma
Teratoma, hepatocellular carcinoma
Small cell lung cancer, gastric cancer, neuroblastoma
Side effects of chemotheraphy
Nausea and vomiting Fatigue- often cyclical GI- mucositis, diarrhoea, constipation Hair loss (not all chemo) Marrow suppression Infertility- Young men--> sperm banks Blood clots
Early and late side effects of radiotherapy
Early: fatigue, mucositis/GI, cystitis, skin (like burns or pain), hair loss
Late: fibrosis, increased risk of other cancers
Which chemo agents cause cardiac SEs?
Anthracyclines (oxorubicin, daunomycin, epirubicin, mitoxantrone)
Which chemo agents cause renal toxicity?
Cisplatin, methotrexate, ifosfamide
Which chemo agents cause neurological SEs?
Vinca alkaloids, cisplatin, taxanes
Which chemo agents cause ototoxicity?
Cisplatin
Which chemo agents cause bladder SEs?
Alkylating agents (Cyclophosphamide, ifosfamide, melphalon, chlorambucil)
In neutropenic sepsis, which antibiotics do you give if someone is pen allergic?
What to you give if they have a PIC line and why?
Meropenem or ceftazidime
Teicoplanin to cover staph aureus
Side effects of platinum-based chemo agents
Ototoxicity, renal toxicity, peripheral neuropathy, hypomagnasaemia
Examples of the vinca alkaloids
Vinblastine, vincristine
How to anthracyclines work?
Topoisomerase inhibitors (inhibit the enzymes responsible for DNA uncoiling)
How to the platinums work?
Bind directly to DNA and cross-link it –> prevent replication and disrupt DNA repair
How do the alkylating agents work?
What are their side effects?
Bind covalently via alkyl groups to DNA and thereby arrest the cell cycle
SE: bladder e..g haemorrhagic cystitis, TCC. Renal toxicity. Myelosuppression.
Which chemo drugs are antimetabolites?
How do they work?
Methotrexate, 5-FU, gemcitabine, pemetrexed
Interfere with nucleic acid metabolism, acting specifically at S phase.
Side effects of antimetabolites
All can cause myelosuppression
Methotrexate: many. Renal toxicity, mucositis, lung and liver fibrosis
5-FU: mucositis, dermatitis
Side effects of the anthracyclines
Cardiac: ECG changes, arrhythmias, cardiomyopathy, heart failure
Which drugs are anti-microtubule agents?
How do they work?
Taxanes (paclitaxel, decetaxel) Vinca alkaloids (vincristine, vinblastine)
Mitotic spindle poisons. Bind tubulin, disrupting polymerisation and inhibiting mitosis.
Side effects of the anti-microtubule agents
Neutropenia
Neurological: peripheral neuropathy, paralytic ileus
Vinblastine can cause myelosuppression.
