Oncology

Question 1

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?

Answer 1

Most common = Nodular sclerosing (associated with lacunar cells)
Best prognosis = Lymphocyte predominant
Worst prognosis = Lymphocyte depleted
Lots of RS cells = Mixed cellularity

Question 2

Causes of SVC obstruction

Answer 2

Lung cancer, lymphoma, mediastinal mets

Question 3

Effects of metastatic spinal cord compression (what happens acutely and chronically)?
What fraction have compression at >1 location?

Answer 3

Acute: direct compression–> oedema, venous congestion, demyelination
Prolonged–> vascular injury and infarction. Any meaningful recovery then unlikely.
1/5 have >1 location affected

Question 4

Median survival of patients with brain metastases. What % of patients with cancer get them?
Standard treatment for palliation of brain mets
Role for chemo?

Answer 4

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

Question 5

VTE prophylaxis in malignancy

Answer 5

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.

Question 6

Symptoms of hypercalcaemia

Answer 6

Lethargy, confusion, anorexia, nausea, constipation, polyuria, polydipsia, bone aches

Question 7

Performance status categories

Answer 7

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

Question 8

Tumour markers for:
Breast
Pancreatic
Ovarian
Colorectal
Prostate

Answer 8

CA 15-3
CA 19-9
CA 125
CEA
PSA

Question 9

What are the following tumour markers for?
S-100
AFP
Bombesin

Answer 9

Melanoma, schwannoma
Teratoma, hepatocellular carcinoma
Small cell lung cancer, gastric cancer, neuroblastoma

Question 10

Side effects of chemotheraphy

Answer 10

Nausea and vomiting
Fatigue- often cyclical
GI- mucositis, diarrhoea, constipation
Hair loss (not all chemo)
Marrow suppression
Infertility- Young men--> sperm banks
Blood clots

Question 11

Early and late side effects of radiotherapy

Answer 11

Early: fatigue, mucositis/GI, cystitis, skin (like burns or pain), hair loss
Late: fibrosis, increased risk of other cancers

Question 12

Which chemo agents cause cardiac SEs?

Answer 12

Anthracyclines (oxorubicin, daunomycin, epirubicin, mitoxantrone)

Question 13

Which chemo agents cause renal toxicity?

Answer 13

Cisplatin, methotrexate, ifosfamide

Question 14

Which chemo agents cause neurological SEs?

Answer 14

Vinca alkaloids, cisplatin, taxanes

Question 15

Which chemo agents cause ototoxicity?

Answer 15

Cisplatin

Question 16

Which chemo agents cause bladder SEs?

Answer 16

Alkylating agents (Cyclophosphamide, ifosfamide, melphalon, chlorambucil)

Question 17

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?

Answer 17

Meropenem or ceftazidime

Teicoplanin to cover staph aureus

Question 18

Side effects of platinum-based chemo agents

Answer 18

Ototoxicity, renal toxicity, peripheral neuropathy, hypomagnasaemia

Question 19

Examples of the vinca alkaloids

Answer 19

Vinblastine, vincristine

Question 20

How to anthracyclines work?

Answer 20

Topoisomerase inhibitors (inhibit the enzymes responsible for DNA uncoiling)

Question 21

How to the platinums work?

Answer 21

Bind directly to DNA and cross-link it –> prevent replication and disrupt DNA repair

Question 22

How do the alkylating agents work?

What are their side effects?

Answer 22

Bind covalently via alkyl groups to DNA and thereby arrest the cell cycle
SE: bladder e..g haemorrhagic cystitis, TCC. Renal toxicity. Myelosuppression.

Question 23

Which chemo drugs are antimetabolites?

How do they work?

Answer 23

Methotrexate, 5-FU, gemcitabine, pemetrexed

Interfere with nucleic acid metabolism, acting specifically at S phase.

Question 24

Side effects of antimetabolites

Answer 24

All can cause myelosuppression
Methotrexate: many. Renal toxicity, mucositis, lung and liver fibrosis
5-FU: mucositis, dermatitis

Question 25

Side effects of the anthracyclines

Answer 25

Cardiac: ECG changes, arrhythmias, cardiomyopathy, heart failure

Question 26

Which drugs are anti-microtubule agents?

How do they work?

Answer 26

Taxanes (paclitaxel, decetaxel)
Vinca alkaloids (vincristine, vinblastine)

Mitotic spindle poisons. Bind tubulin, disrupting polymerisation and inhibiting mitosis.

Question 27

Side effects of the anti-microtubule agents

Answer 27

Neutropenia
Neurological: peripheral neuropathy, paralytic ileus
Vinblastine can cause myelosuppression.