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Exam > Oncology > Flashcards

Oncology Flashcards

1
Q

Cell cycle phases

A 
Gap 0 = no division
Interphase:
- G1 (Cells increase in size, G1 checkpoint)
- Synthesis (DNA replication)
- G2
Mitosis
- Prophase
- Metaphase
- Anaphase
- Telophase
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2
Q

Chemo agents that affect mitosis

A

Antimicrotubule agents eg. vinca alkaloids
Topoisomerase II inhibitors eg/ anthracyclines
Etoposide

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3
Q

Chemo agents that are not specific to any cell cycle phase

A

Alkylating agents

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4
Q

Chemo agents that affect the S phase

A

Antimetabolites eg. methotrexate
Topoisomerase II inhibitors eg. anthracyclines
Prednisolone

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5
Q

Alkylating agents MOA and examples

A

Contain chemical groups that form covalent bons with particular nucleophilic substances in the cell -> interferes with transcription and replication

Cyclophosphamide
Ifosfamife
Cisplatin
Carboplatin

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6
Q

Alkylating agents general side effects

A

Bone marrow depression
GI disturbance
Gametogenesis –> sterility esp in men with prolonged used
Increased risk of non-lymphocytic leukaemic and other malignancies with prolonged use

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7
Q

Cyclophosphamide side effects

A

N/V
Bone marrow depression- pronounced effect on lymphocytes
Haemorrhagic cystitis (due to toxic metabolite acrolein, minimised by NAD/mesna which interact with acrolein)
Bladder cancer
Pulmonary fibrosis
SIADH
Anaphylaxis

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8
Q

Ifosfamide side effects

A

N/V
Bone marrow depression- pronounced effect on lymphocytes
Haemorrhagic cystitis (due to toxic metabolite acrolein, minimised by NAD/mesna which interact with acrolein)
Bladder cancer
Pulmonary fibrosis
SIADH
Anaphylaxis

*More cardiac toxicity than cyclophosphamide

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9
Q

Cisplatin side effects

A 
Nephrotoxic 
* Low myelotoxicity 
Severe N/V, can be delayed
Tinnitus and hearing loss in the high frequency range 
Peripheral neuropathy
Hyperuricaemia
Anaphylaxis
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10
Q

Carboplatin side effects

A

Similar to cisplatin- more myelotoxicity, less of the other side effects

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11
Q

Antimetabolites examples

A

Folate antagonists eg. methotrexate
Pyrimidine analoges eg. fluorouracil, cytarabine
Purine analogues eg. metcaptopurine,

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12
Q

Methotrexate
MOA
Side effects

A

Folate is requires for synthesis of purine nucelotide and thymidylate
MTX inhibits dihydrofolate reductase

Bone marrow supression
Mucositis, stomatitis
Dermatitis
Hepatitis
Nephrotoxicity (high dose- caused by precipitation in the tubules)
CNS toxicity (high dose)
Don’t give if there are fluid compartments eg. pleural effusions, ascites

IT: arachnoiditis, leukoencephalopathy, leukomyelopathy

Long term- osteopenia + #s

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13
Q

Fluorouracil
MOA
SEs

A

Inhibits thymidalate synthesis

Usual
Cerebellar disturbances

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14
Q

Cytarabine
MOA
SEs

A

Inhibits DNA polymerase

Usual
Conjunctivitis
IT: CNS dysfunction

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15
Q

Mercaptupurine

A

Converted to a fraudulent purine nucleotide

Hepatic necrosis
Mucositis
Allopurinol increases toxicity by inhibiting metabolism

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16
Q

Cytotoxic antibiotics
MOA
Examples

A

Produce their effects through direct action on DNA
Do not give with radiotherapy
Eg. anthracyclines (doxorubicin, idarubicin, daunorubicin)
Dactinomycin, bleomycin, hydroxyurea

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17
Q

Doxorubicin

A

Inhibits DNA and RNA synthesis by interfering with topoisomerase II

Necrosis with extravasation
Usual
Dose related cardiac damage
Marked alopecia 
Red urine
COnjunctivitis
Radiation dermatitis
Arrythmia
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18
Q

Dactinomycin

A

Topoisomerase II

Necrosis with extravasation
Usual
*No cardiac damage unlike doxorubicin
Marked alopecia 
Red urine
Conjunctivitis
Radiation dermatitis
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19
Q

Bleomycin

A

Fragmentation of DNA chains
Often used for germline cancers

*Little myelosupression 
Pulmonary fibrosis 10%, fatal 1%
50% muycocutaneous reactions esp palsm 
Hyperpyrexia
Raynaud phenomenon
Dermatitis
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20
Q

Hydroxyurea

A

Urea analogue that inhibits ribonucleatase reductase

Usual, but sigifiant bone marrow supression

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21
Q

Vinca alkaloids MOA

A

Bind to tubulin and inhibitos polymerisation to microtubules –> arrests that cell cycle at metaphase

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22
Q

Vincristine

A 
*Only mild myelosupression
Parasthesias and peripheral neuropathy
Constipation, ileus
Abdo pain
Muscle weakness
Local cellulitis, extravasation reactions
Jaw pain
SIADH
Seizures 
Ptosis
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23
Q

Vinblastine

A

Less neurotoxic than vincristine
Leucopenia
Still has same issues with cellulitis and extravasation

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24
Q

Etoposide

A

o Inhibits topoisomerase II and inhibits mitochondrial function
o Nausea, vomiting, myelosuppression, alopecia

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25
Q

Campothecins eg. irinotecan, topotecan

A

Inhibit topoisomerase I

Dairrhoea, bone marrow supression
Generally fewer side effects than other chemotherapy agents

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26
Q

Asparaginase

A

Selective action on leukaemia cell, which are unable to synthesis their own aspariginase

Minimal bone marrow suppression, GI effects or alopecia
Marked anaphylaxis
N/V
CNS depression
Liver damage
Pancreatitis
Platelet dysfunction and coagulopathy
Hyperglycaemia
Encephalopathy
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27
Q

Rituximab

A

Used for lymphoma
Lyses B lymphocytes by binding to CD20 and activating complement
Hypotension, fever, hypersensitivity

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28
Q

Imatinib

A 
Inhibits signalling pathway kinases including tyrosine kinase and Bcr/Abl kinase
Abdo pain, diarrhoea, nausea
Fatigue
Headache
Rash
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29
Q

5 year survival rate for all childhood cancers

A

83.5%

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30
Q

Risk factors for ALL

A

Ionising radiation
White race
T21- 10-20x higher
NF1, Bloom syndrome, ataxia-telangiectasia, Langerhan’s cell histiocytosis

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31
Q

Risk factors AML

A

Alkylating agents (cyclosphophamide) + etoposide
T21
NF1
Familial monsomy 7

32
Q

Li-Fraumeni

A

p53 mutation
AD
3 criteria:
- Proband Dx with sarcoma <45 years
- 1st degree relative with any cancer Dx <45 years
- Another 1st or 2nd degree relative with any cancer <45 years or sarcoma any age

33
Q

WAGR

A

Wilm’s tumour, aniridia, genitourinary anomalies, mental retardation
WT1 gene- chromosome 11p deletion

34
Q

Risk factors hepatoblastoma

A

Beckwith-Wiedeman, hemihypertrophy, Gardner syndrme, adenomatous polyposis

35
Q

Chromosome 13q deletion syndrome

A

Retinoblastoma and sarcoma

36
Q

Monosomy 5 and monosomy 7

A

Myelodysplastic syndrome

37
Q

Tyrosinaemia

A

Hepatocellular carcinoma

38
Q

Galactosaemia

A

Hepatocellular carcinoma

39
Q

Acute adverse effects of radiation therapy

A 
Dermatitis (MC)
Nausea, diarrhoea (abdo radiation)
Mucositis
Somnolence (cranial radiation)
Alopecia (scalp radiation)
40
Q

Late effects of radiation therapy

A

Impaired growth (cranial or vertebral)
Endocrine dysfunction (Cranial)
Pulmonary or cardiac insufficiency (chest)
Strictures and adhesions (abdo)
Infertility (pelvic)
Secondary malignancy in the radiation field

41
Q

Tumour lysis syndrome

A

High urate, phosphate, potassium
Renal dysfunction
Hypocalcaemia
Usually seen within 12-48 hours of chemo
Allopurinol (xanthine oxidase inhibitor) prevents further accumulation of urates
Rasburicase - enzyme that degrades uric acid

42
Q

High risk for neurocognitive deficits after cancer

A 
Age <3 at time of Rx
Female
Supratentorial tumours
Premorbid/FHx of learning or attention problems
Radiation doses >24Gy
Whole brain irradiation
43
Q

High risk for SNHL after cancer

A

Higher dose cisplatin
Higher radiation dose >30Gy
Concurrent radiation and cisplatin

44
Q

High risk for gondal dysfunction after cancer- delayed puberty, premarity menopause, infertility

A

High dose alkylating agents eg. alkylating agent conditioning for HSCT
Radiation dose >15Gy in prepubertal girls, >10Gy in pubertal girls
Pelvic/gonadal irradiation in boys

45
Q

High risk for caridac issues post cancer

A 
Females
Age <5 at time of Rx
High doses chemo >300mg/m2 - daunorubicin, doxorubicin, idarubicin
High dose cardiac radiation
Combined cardiac chemo and cardiac radio
46
Q

Cancers most commonly associated with secondary malignancy

A
  1. RB (50% at 50 years)
  2. Hodgkin lymphoma
  3. Soft tissue sarcoma
47
Q

B- ALL favourable chromosome

A 
T4
T10
T17
T(12;21) ETV6-RUNX1
Hyperdiploidy
48
Q

B-ALL unfavourable chromosomes

A

t(4;11) MLL-AF4
t(9;22) BCR-ABL
Hypodiploidy

49
Q

T4 in ALL

A

Favourable

50
Q

T10 in ALL

A

Favourable

51
Q

T17 in ALL

A

Favourable

52
Q

ETV6-RUNX1

A

Favourable

t(12;22)

53
Q

t(1;19) E2A-PBX

A

No prognostic implication

54
Q

MLL-AF4

A

Unfavourable

t(4;11)

55
Q

t(8;14)

Burkitt leukaemia

A

No prognostic implication

56
Q

t(10;14)

T-ALL

A

Favourable

57
Q

MLL rearrangments

A

Occur in infant leukaemia (60% infant leukaemia, 5% all leukaemia)
11q23
Unfavourable
Results in t(4;11), t(11;19), t(9;11)

58
Q

Higher leukocyte count in T or B ALL

A

T-ALL

59
Q

Occult testicular involvement in what % of boys with leukaemia at diagnosis

A

25%

60
Q

Diagnosis of ALL

A

Bone marrow with >25% of marrow cells as a homogenous population of lymphoblasts

61
Q

Standard risk ALL

A

Age 1-10

Leukocyte count <50

62
Q

High risk ALL

A

Age <1 or >10

Leukocyte count >50

63
Q

Very high risk ALL

A 
Philadephia
MLL
T-ALL
Slow response to initial therapy
Hypodiploidy
IKZF1
MRD >0.01 on day 29 of induction
64
Q

TPMT gene

A

Thiopurine S-methytransferase
Wild type = normal
Heterozygous = slightly decreased enzyme activity
Homozygous = low or absent enzyme activity
Decreased TPMT activity needs a lower 6-MP dose to prevent severe myelosupression

65
Q

Percentage of patients with ALL who relapse

A

15-20%
<5% CNS relapse
<2% boys testicular relapse
- TALL more likely during Rx, BALL more likely after treatment

66
Q

Chloromas

A

Subcutaneous AML deposits
Esp t(8;21)
Can occur in the absence of bone marrow involvement

67
Q

Favourable chromosomes AML

A

t(8;21) AML1-ETO
inv(16) CBFB-MYII
t(15;17) PML-RARA

68
Q

Unfavourable chromosomes AML

A

11q23 MLL
PLT3
Del(7q), -7

69
Q

AML survival

AML survival post transplant

A

60-70%

2/3 disease free survival

70
Q

APL

A

Gene rearrangment involving the retinoic acid receptor t(15;17) PML-RARA
Very responsive to ATRA combine with anthracyclines and cytarabine

71
Q

Leukaemia and Down syndrome

A

Acute leukaemia 15-20x more common than gen pop
AML 400x more common in first 3 years, after this same as general population
Prognosis with ALL slightly worse than gen pop, AML slightly better (80% survival)
Very sensitive TO MTX- needs lower doses

72
Q

Transient leukaemia/myloproliferative disorder in Down syndrome

A

10% of neonates
Elevated WCC, blasts in peripheral blood, anaemia, thrombocytopenia, hepatosplenomegaly
Resolves without Rx in first 3 months
Can require transfusions
Chemo only if life threatening complications
20-30% develop leukaemia by age 3- usually megakaryoblastic AML
Assoc with GATA1 mutation

73
Q

CML

A

99% of cases t(9;22)
Chronic phase for 3-4 years, then blast crisis
Imatinib
Hydroxyurea to control WCC in chronic phase
BMT curative in 80%

74
Q

JMML

A

Typically <2 years
Assoc with Noonans (PTPN11) and NF1 (RAS oncogenes)
Anaemia with erythroblasts
Bone marrow shows a myelodysplastic pattern with <20% blasts

75
Q

Hodgkin lymphoma

A

MC malignancy 15-19 yrs
Assoc with HHV6, CMV, EBV (EBV infection = 4x greater risk HL)
Reed-Sternberg cells
CD30 and CD40 positive

76
Q

RET

A

Multiple endocrine neoplasias

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