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3b > Oncology > Flashcards

Oncology Flashcards

1
Q

Metaplasia & 2 examples

A

transformation of one terminally differentiated cell into another e.g. Barrett’s = squamous -> glandular, cigarettes = respiratory to squamous

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2
Q

Dysplasia

A

Abnormal increased cell growth with 1) cellular atypia 2) decreased differentiation (pre-malignant, but reversible at early stage)

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3
Q

Carcinogenisis

A

Transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations

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4
Q

Carcinogen

A

Mutagenic and cause cancers (85% of cancer risk = environmental)chemical, viral, radiation (mel), hormones (breast), parasites (schist)

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5
Q

Characteristics of benign tumours

Morbidity and mortality

A 
Localised
Non-invasive
Closely resemble normal structure
Circumscribed/encapsulated
Nuclear morphology = normal

Pressure on adjacent structures
Flow obstruction
Hormone production
Transformation to malignant

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6
Q

Characteristics of malignant tumours

Morbidity and mortality

A 
Invasive
Metastatic
Rapid growth
Variable resemblance to normal structure
Poorly defined border (crablike)
Increased mitotic activity
Destroy surrounding tissue
Metastases
Blood loss ulcers
Flow obstruction
Hormone production
Paraneoplastic syndrome
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7
Q

Papilloma

Adenoma

Carcinoma

Adenocarcinoma

A

Benign epithelial neoplasm non-glandular, non-secretory e.g. SCP

Benign epithelial neoplasm of glandular/secretory

Malignant tumour of epithelial cells e.g. transitional cell carcinoma

Malignant tumour of glandular/secretory epithelium

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8
Q

TMN staging

A

T: T0 (main tumour not found), TX (main tumour cannot be measured), T1-4 (size and extent)

N: N0 (no cancer in nearby LN), NX (cancer in LN cannot be measured), N1 (tumour to local LNs), N2 (between N1 and N3), N3 (to distant LNs)

M: MX (mets cannot be measured), M0 (no metastasis), M1 (cancer spread)

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9
Q

Indications for radio therapy

A 
Pt medically unfit surgery
Anatomically unresectable
Close proximity to vital structures
Neo-adjuvant to shrink structure, 
Palliative for bone/brain mets + spinal cord compression
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10
Q

Acute complications of radiotherapy

A

Fatigue (80%)
Skin - Erythema, dry and moist desquamation, irritation
GI - loss of taste, oral mucositis (complicated by yeast/bacterial superinfection), diarrhoea, nausea, vomiting
BM - cytopenias
Lungs - pneumonitis, fever, cough, dyspnoea

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11
Q

Chronic complications of radiotherapy

A 
Infertility
Lymphoedema
Delayed healing
Loss of salivary flow
Transverse myelitis, Lhermitte’s 
Increased risk CV events/stroke
Hypothyroidism
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12
Q

Chemo side effects

A

Myelosuppression - anaemia, neutropenia, thrombocytopenia (1-2 weeks)
Alopecia
Infertility
Nausea, vomiting and diarrhoea - use domperidone or metoclopramide
Fatigue
Teratogenicity
Mouth ulcers

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13
Q

Anaphylaxis management

A 
Airway managment & 100% O2
Remove the cause & raise legs
Adrenaline 0.5mg IM 1:1000
Iv access - Chlorenphenamine 10mg & Hydrocortisone 200mg
Fluids
If wheeze treat for asthma
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14
Q 
Neutropenic sepsis
What
Presentation
Management
Risk factors
A

Suspect with fever in anyone who has had chemotherapy in the last 6W!

Defined as severe neutropenia = < 1 x 10^9/L (mod = 0.5-1)
Temps, new onset confusion, tachycardia, hypotension, hypothermia

Tazocin/Merepenem (if on Methotrexate - Both folate inhib) . Vanc if MRSA
+ GCSF can boost bone marrow production

Type of chemo, length of chemo, elderly

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15
Q

Spinal cord compression

A

PAIN ± sensory loss at level ± weakness below level ± loss of continence

MRI whole spine, refer to neurosurgery/spinal surgery + IV DEXAMETHASONE + prevention VTE

70% are thoracic

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16
Q

Oncological emergencies

A 
Neutropenic sepsis
Spinal cord compression 
Anaphylaxis 
SVC obstruction 
Acute tumour lysis syndrome
Hypercalcemia
PE
17
Q

Hypercalcemia aetiology (5)

A

Humoral (due to tumour produced PTH related peptide) - renal, ovarian, breast, endometrial, squamous cell carcinoma

Local release of osteolytic factors - breast, multiple myeloma

Calcitriol mediated - lymphoma and granulomatous disease

Ectopic PTH (small cell lung Ca)

20% due to unrelated hyperparathyroidism

18
Q

Symptoms of hypercalcemia

A

Dehydration + bones, stones, abdominal moans, thrones, psychic overtones
Poor skin turgor/dry mucous membranes (DEHYDRATION)
Bone pain (BONES)
Abdominal pain (STONES)
Constipation, loss of appetite, nausea (ABDOMINAL MOANS)
Polyuria + polydipsia (THRONES)
Confusion + fatigue (PSYCHIC OVERTONES)

19
Q

Tretament of hypercalcemia

A

Mod/severe
IV normal saline (reverses dehydration secondary to hypercalcaemia induced nephrogenic diabetes insipidus)
IV bisphosphonates/denosumab (zoledronic acid) - block osteoclastic bone resorption
Furosemide to avoid fluid overload

20
Q

Symptoms of SVC obstruction

A

Oedema of face and upper extremities (80%)
Dyspnoea (60%) - worse leaning forward
Facial plethora (venous engorgement)
Cough
Distended neck veins + chest veins - worse leaning forward
Hoarse voice

FIXED (non-pulsatile) & RAISED JVP

21
Q

Tumour lysis syndrome

A

2 of
Hyperuricaemia + reduced urinary flow -> uric acid crystals, renal tubule obstruction and decline in renal func (AKI)
Hyperphosphataemia -> calcium phosphate crystals -> nephrocalcinosis and urinary obstruction
Secondary hypocalcaemia due to hyperphosphataemia
Hyperkalaemia from cell degradation

AKI -> fluid overload and pulmonary oedema

22
Q

Acute treatment of tumour lysis syndrome

A 
Treat hyperkalaemia
Intense fluid resuscitation
Phosphate binder
Rasburicase
Alopurinol

->If severe dialysis

23
Q

Cancers that can metastasise to bone

A 
Breast.
Prostate.
Lung.
Kidney.
Thyroid.
24
Q

Lambert-Eaton Myasthenic Syndrome

A

Rare AI disorder of NM junction associated with SCLC (50%) + smoking + AI disease

Limb weakness (proximal legs + arms)
Dry mouth (xerostomia + metallic taste) - autonomic
Weakness (Limb girdle + waddling gait)
Dysarthria, ptosis, diplopia, impotence

25
Q

Carcinoid syndrome

A

Symptoms due to secretion of serotonin and kinins (vasoactive peptides) from neuroendocrine tumours (gastric carcinoma, bronchial adenoma - carcinoid type, pancreatic carcinoma)

Commonly presents with flushing/diarrhoea (± wheeze, palpitations, telangiectasia, abdo pain)

Treatment - medical therapies (octreotide - somatostatin analogue) + surgical resection

26
Q

Metastatic spinal compression Mx

A

Dexamethasone IV
Radio if multiple metastasis
Decompression surgery if single bone met

3b (15 decks)

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