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Final > Oncology > Flashcards

Oncology Flashcards

1
Q

Hypertrophy Vs Hyperplasia

A

Inc size Vs Inc number

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2
Q

Metaplasia

A

Transformation of one terminally differentiated cell into another (e.g. Barretts)

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3
Q

Dysplasia

A

Cellular atypia and decreased differentiation
Changes are pre-malignant and reversible

End stage of spectrum = anaplasia

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4
Q

Apoptosis Vs Necrosis

A

Apoptosis = Programmed cell death of unwanted individual cells. monitored by p53

Necrosis is cell death from ischaemia, metabolic or traumatic cause

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5
Q

What happens to cell in apoptosis Vs Necrosis

A

Cell shrinkage and fragmentation (blobbing) for phagocytosis.
Dense chromatin

Cell swelling and lysis with spilling out of DNA

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6
Q

Carcinogenensis def

A

Normal -> neoplastic cell transformation through permanent genetic mutations
Inc growth and dec cell death

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7
Q

Carcinogen def

A

Mutagenic (Chemical, viral, radiation - melanoma, hormones - breast/prostate, parasite - schist

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8
Q

Neoplasm def

A

a new lesion from autonomous abnormal growth of cells which persists after initiating stimulus is removed (benign or malignant)

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9
Q

Benign Vs malignant features

A

Bening:
Localised, non-invasive, well differentiated, encapsulated, normal morphology, necrosis/ulceration (rare - doesn’t outgrowth blood supply that fast)
Growth up and out

Malignant:
Invasive, metastatic, rapid growth (ulceration and necrosis), Poorly differentiated cells, inc mitotic activity, growth down and in

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10
Q

Benign tumour morbidity

A

Pressure on adjacent
Flow obstruction
Hormone production
Malignant transformation

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11
Q

Malignant tumour morbidity

A 
Destroy surrounding tissue, 
Metastasise, 
Flow obstruction, 
Hormone production
Paraneoplastic features
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12
Q

Papilloma
Adenoma

Carcinoma
Adenocarcinoma

Lipoma/Osteoma/Angioma for e.g.

Sarcoma

A

benign epithelial neoplasm

Benign secretory epithelial neoplasm

Malignant epithelial tumour

Malignant secretory epithelial neoplasm

Benign connective tissue tumour

Malignant connective tissue tumour

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13
Q

Metastatic cascade

A

1) detachment
2) invasion
3) Intravasation (blood/lymph)
4) Evades host immune system
5) Adherence
6) Extravasation
7) Angiogenesis

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14
Q

Forms of metastatic spread

Mets are the main cause of cancer death

A

Lymphatic (to LNs)

Haematogenous (Organs, bone)

Transcoelomic (within body cavity e.g. pleural, peritoneal mets)

Iatrogenic (e.g. needle tracking)

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15
Q

Cancer grading:

  • Low Vs High grade
  • Relevance
A

Low = well differentiated

High = poorly differentiated

Degree of differentiation correlated with outcome

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16
Q

TNM

A

Tumour (extent of main tumour)

Nodes (Presence and extent of LN spread)

Metastasis

X after any = can’t be measured.
0 = none can be found

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17
Q

Cancer treatment methodologies

A

Surgery (curative)
Radiotherapy (curative)
Chemotherapy
Immunotherapy

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18
Q

Important factors when deciding Tx

A

Patient factors (Kornofsky state of health score: 0-100% full health)

Cancer Stage/Grade

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19
Q

Radiotherapy

  • Purpose
  • What is it
  • How it is used
  • Typical Regimen
A

Curative and palliative use

High energy x-ray beams precisely delivered cause DNA damage

Sole Tx or with surgery/chemo

  • Neoadjuvant: before
  • Adjuvant: post

Daily

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20
Q

Radiotherapy indications

A

Neoadjuvant - Shrink structure to make it resectable (if close to vital structures)

Adjuvant - decrease recurrence

Palliative for bone/brain mets and spinal compression

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21
Q

Types of radiotherapy

A

External beam (CT/MRI targeted)

Internal radiation (Brachytherapy) source placed close to tumour

Stereotactic: very accurate directed Tx good for small elsions

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22
Q

Radiotherapy SE/Complications

  • Acute
  • Chronic
A

Acute: Fatigue, Skin (erythema, desquamation, irritation), GI (loss of taste, oil mucositis, D&V), BM-Pancytopenia
Lung - pneumonitis, fever, cough, dyspnoea

Infertility, Lymphoedema, delayed healing, inc risk CV disease/stroke

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23
Q

Chemotherapy

  • When is the only time curative
  • How used
  • Example of regimen
  • What cell affected
A

In leukaemia, lymphomas

Neo-adjuvant (before surgery), adjuvant (post surgery - curative aim), Palliative - often with radiotherapy

e.g. 3 weekly cycles to allow normal cell recovery

Fast replicating cells (gut mucosa, hair, bone, BM)

24
Q

Routes of chemo

A 
Oral
IM
IV
Intrathecal
Topical
25
Q

Types of Chemo:

  • Alkylating
  • Cytotoxic
  • Antimetabolite
  • Topoisomerase inhib
  • Mitotic inhib
  • Platinum compounds
A
  • Alkylating
    Chlorambuclin, Darcarbazine
  • Cytotoxic
    Doxorubicin, Bleomycin
  • Antimetabolite
    5-FU, MTX
  • Topoisomerase inhib
    Etoposide
  • Mitotic inhib
    Vincristine, Paclitaxel
  • Platinum compounds
    Cisplatin
26
Q

Chemotherapy side effects

A

Myelosuppression (anaemia, infection, bleeding)

Alopecia

Infertility

N&V&D (domperidone, metoclopramide)

Fatigue

Mouth ulcers

Peripheral neuropathy

Teratogenicity

27
Q

Immunological therapies: Monoclonal antibodies (main form): How it works and E.G.

A

Antibody produced by single clone of cells

Bind specific target e.g. cancer specific antigens, stop blood vessels, block proteins that down reg immune surveillance by cancer

Trstuzumab/herceptin - against Her-2

Pembrolizumab - blocks programmed cell death protein 1 on lymphocytes

Cetuximab - block VEGF prod through TK inhibition

28
Q

Immediate risk factor in administering chemo

Management

Beware of?

A

Anaphylaxis

Stop drug
ABCDE, IM adrenaline (0.5mg), IV hydrocortisone + Chlorphenamine

May recur at 4-12hrs

29
Q

Neutropenis sepsis + chemo

  • why happens
  • definition
  • when to suspect + why difficult
  • Ix + Tx
A

Myelosuppression in chemo

Neutrophil count less than 1 per high power field

Suspect in anyone with fever who has had chemo in last 6 weeks (May not get fever - atypical pres)

BUFALO, sam central lines

Abx- IV Piperacillin and tazobactam (Tazocin) or Gentamycin. May also add fluconazole (thrush) acyclovir (varicella zoster - shingles)

30
Q

Spinal cord compression

  • When
  • Pres
  • Site
  • Ix & Tx
A

3-5% cancer, 10% spinal mets

Pain ± sensory loss/weakness below level ± lost continence

70% thoracic, 20% lumbosacral (below L1/2 think cauda equina)

MRI spine, neuro/spinal surgical referral, IV DEXAMETHASONE

31
Q

Spinal mets Tx

A

Analgesia (NSAID, Para, Opiates)
Bisphosphonates (lytic lesions: breast, myeloma)
Palliative radiotherapy
Vertebroplasty

32
Q

DVT/PE in Ca

  • why
  • mech
A

Cancer and treatment are prothrombotic (higher PT and clotting factors)

Surgery and chemo damage vessel walls (inc clots)

Patients tend to be less active

33
Q

DVT Tx

A

Immediate LMWH

Long term

  • 3 - 6 month Warfarin +
  • NOAC 3 month (Rivaroxoban)
34
Q

Haemorrhage in cancer/chemo

  • Mechanisms
  • Tx
A

Both chemotherapy and disease process may lead to low platelets

Cancer may cause direct erosion of blood vessels (n.b. major blood vessel = fatal)

Decreased clotting factors with liver metastasis or chemotherapy

NSAIDs for pain, topical tranexamic acids/adrenaline soaks, oral tranexamic acid

35
Q

Hypercalcaemia in malignancy

  • Mechanisms (3)
  • % of malignancies
A

PTH related peptide secretion by tumour (humoral hypercalcaemia)
- renal, ovarian, breast, SCC

Local osteolytic hypercalcaemia
- Mets in breast, myeloma etc

Calcitriol prod by lymphoma (over prod of active Vit D)

10% of malignancies
20% of hypercalcemias

36
Q

Hypercalcaemia of malignancy

- Symptoms

A

Bones (pain)

Stones

Abdo moans (nausea, loss of appetite, constipation)

Thrones (polyuria, polydipsia)

Psychic Overtones (confusion, fatigue)

37
Q

Investigations hypercalcaemia of malignancy

A

Total calcium
Serum PTHrP (humoral)
Serum Calcitrol (Lymphoma)
Resting ECG

38
Q

Treatment hypercalcaemia of malignancy

A

Treat underlying malignancy

Avoid meds that worsen (Thiazides, calcium sups, antacids, lithium)

IV normal saline, Bisphosphonates (Zoledronic acid - block osteoclast resorption_

Furosemide avoid fluid overload

39
Q

SVC obstruction

  • Most commonly caused by what disease?
  • Mechansim of obstruction (2)
  • Specific causes
A

Most common cause is cancer

Intraluminal obstruction / external compression blocks venous return from head/thorax/upper extremities

75% lung cancer
15% Non-hodgkin lymphoma
10%metastasis from breast/colon/oesophaguis
Rest obstruction from other mediastinal cancer( Thymoma, germ cell etc)

40
Q

SVC obstruction symptoms

A 
Oedema of face & upper extremities
Dyspnoea
Facial plethora (venous engorgement)
Cough
Distended neck veins/Chest veins
Hoarse voice
Raised JVP (Fixed, non-pulsatile)
41
Q

Investigations SVC obstruction

A

CXR (Widenened mediastinum or mass in lung)

CT thorax

USS upper extremities (dilated SVC, thrombus)

42
Q

Complication of SVC obstruction + what must be done..

A

Acute airway obstruction

Secure airway

43
Q

SVC obstruction Tx

A

Treat malignancy

Local radiotherapy and Dexamethasone (IV)

44
Q

Tumour lysis syndrome

  • Def
  • Common cause
  • Diagnosis (Lab + Clinical)
A

Metabolic/Electrolyte abnormalities occurring following initiation of cytotoxic Tx in cancer.
Due to excessive cell lysis.

Highly proliferative chemosesnitive malignancies e.g. lymphoma & leukaemia

Lab TLS: (2 of) hyperuricaemia, hyperphosphataemia, hyperkalaemia, HYPOcalcaemia

Clinical TLS: Inc serum creatinine, arrhythmia (K+, hypoCa, PO4), Seizure (hypoCa - muscle cramps, tetany

45
Q

TLS pathophys

  • AKI
  • HypoCa
  • HyperK+
A

High turnover of tumour cells/destruction by chemo = nucleic acid products )uric acid) + phosphate

Uric acid/Phosphate crystals cause renal tubular obstruction -> AKI

Hyperphosphataemia causes secondary hypercalcaemia (Calcium bound to form calcium phosphate)

Cell degradation = high K+

46
Q

Tumour lysis syndrome

  • RF
  • Pres
  • Ix
A

Haematological malignancy, chemosensitive, renal impairment, dehydration

Syncope, chest pain, seizure, N&V, diarrhoea, muscle cramps/weakness

Serum: high potassium, uric acid and phosphate, low calcium
Elevated lactate dehydrogenase and serum urea
ECG - electrolyte disturbance

47
Q

Acute TLS Tx

A

Glucose+Insulin and salbutamol for hyperkalaemia

Intense fluid resus

Phosphate binder

Rasburicase (uric acid binder in blood)

48
Q

Preventing TLS

A

Prechemo IV hydration
Regular monitoring (bloods, ECG)
Phosphate binder
Uric acid binder (Rasburicase)

49
Q

Paraneoplastic syndrome

  • what
  • common with
A

This syndrome is consequence of cancer in body but not due to local presence of cancer cells

mediated by humoral factors (hormones, cytokines) secreted by cancer cells or by immune response to tumour.

Breast, lung, ovary, lymphomas

50
Q

Lung small cell paraneoplastic syndromes

A

Hyponatraemia (dilutional): inappropriate ADH secretion

Cushings: ACTH-like substance

51
Q

Squamous cell lung cancer paraneoplastic syndrome

A

Hypercalcaemia due to parathyroid like substance

52
Q

Carcinoid paraneoplastic syndrome

  • pres
  • cause
  • Ix
  • Tx
A

Flushing, diarrhoea, palpitations

Serotonin release from neuroendocrine tumours. Often seen when mets to Liver

24 hr urinary 5HIAA

Ocretoide (somatostatin analogue - inhibits secretion of many hormones)
Surgical resection

53
Q

Which cancers mets to bone?

What type of lesion

A

Breast - Lytic or sclerotic

Prostate- sclerotic

Lung - lytic

Thyroid - lytic

Myeloma -lytic

54
Q

Familial cancer syndromes

A 
MEN
NF
Retinoblastoma (assoc with sarcoma)
Ataxia telangiectasia
HNPCC/Lynch syndrome
FAP
VHL (Loss of HIF1-a degradation)
55
Q

Sanctuary sites for cancers

A

These are areas chemotherapy does not reach well

e.g. Brain and scrotum

56
Q

E.G of

  • Viral Carcinogen
  • Chemical Carcinogen
  • Hormonal Carcinogen
  • Parasitic Carcinogen
  • Exposural Carcinogen
A

Hep B, HHV-8, HPV-16/18

All, Smoking, Nitrosamines (pickled food)

Oestrogen (breast), Testosterone (Prostate)

Schistosomiasis

Asbestos, dyes/rubber industry

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