Oncology Flashcards
Welcome to oncology
“Big pharma has the cure for cancer”
How does radiotherapy treat cancer?
Breaks the double stranded DNA leading to cell death in all cells. Normall cells recover faster than cancerous cells.
What is a fraction when referring to radiotherapy?
A dose of radiothearpy
What the difference between palliative and radical radiotherapy?
Radical aims for cure and takes longer to plan.
Palliative aims to control symptoms and is quicker to plan (next day)
How can radiotherapy cause side effects?
Inflammation - acute
Fibrosis and scaring - chronic
What side effects of radiothearpy can be atributed to inflammation?
Fratigue
Pain flare from bones
Site dependent inflamation
D&V
raised ICP
skin irritation
What side effects of radiothearpy can be atributed to fibrosis?
Stricutres
Oesteonecrosis
Rib fractures
2nd malignancies
What is the main type of chemo thearpy?
Cytotoxic chemotherapy
What is the aim of adjuvant chemotherapy?
Stop relapse (via micro metastesis) after curative treatment
What is Neo-adjuvant therapy?
Treatment of tumour in order to reduce size or “buy time” for curative treatment
How can chemotharpy attenuate radiotherapy?
Chemothaerpy agenst like gemcitabine can increase radiotherapy effectiveness
What would chemotherapy side effects would be dose limiting (e.g: pause or reduce chemotherapy dose)?
Neutropenia
Thrombocytopenia
mucositis (GI tract)
D&V
alopecia
Peripheral neuropathy
What oncological emergencies are there?
Neutropenic sepsis
Tumour lysis syndrome
Spinal chord compression
Hypersensitivity
Superior vena cava obstruction
Malignancy associated hypercalcaemia
Brain mets
What is brachytherapy?
High dose radioactive source placed locally to the tumour. Often used uterus prostate
What is stereotactic radiotheraoy?
Highly acurate conventional external beam radiotherpy (ERBT) to target small tumours with precision (e.g: Gamma knife). Treatment of intacranial tumours
What is defined as neutropenic sepsis?
Temp > 38ºC
Neut count <0.5x10^9/L
What is the treatment neutropenic sepsis?
Sepsis within 1 hour
What is the Sepsis 6?
3 in:
IV fliuds
IV antibiotics
O2 (if < 94%)
3 out:
ABG for lactate
Cultures
Urine output
What is hypersensitivity
Anaphlyaxis after 2 or mre doses
Treat by stopping the offending drug then:
fliuds
Immunosupression -steroids and anti-histamines
What is tumour lysis syndrome?
Hyperureaemia
hyperkalaeima
hyperphsophateamia
potentially occompanying renal failure
What is the pathophysiology of tumour lysis syndrome?
Rapid tumour cell destruction releasing itracellular contents. Often lymphoma, leukaemias or germ cell cancers
Phosphate and uric crystals form in kidneys leading to renal failure
How is Tumour lysis syndrome treated?
Prevention is better:
Allupurinol or Rusburicase
fluids
monitoring and ID at risk pt.
What is superior vena cava (SVC) syndrome?
Reduced venus return from head and neck due to tumour compression partially occluding the SVC
How is SVC syndrome treated?
Avoid hypoxia
Dexamethasone
Organise - SVC stenting or radiotherapy
What are the symptoms of spinal chord compression?
Pain which radiates from back to front - nocturnal worse on straining
UMN signs - neuro defecit, sesory loss, ataxia
Bladder or bowel symptoms
How is spinal chord compression treated?
Dexamethasone - PPI
MRI spine
Radiolotherapy within 24 hours
What is ECOG?
A performance score form 0 to 5
What is ECOG score 3?
> 50% of day in bed or chair
What is ECOG 2?
< 50% of day in chair or bed
What cancer can HPV cause?
Cervical
Head and neck
What is Li-Fraumeni syndrome?
TP53 mutation leading to muiltiple early cancers
What is would be shown in the blood test for malignancy associated hypercalcaemia?
Raised calcium (inc. corrected), ALT and urea
How is oncologically related hypercalcaemia treated?
Dilution and dieresus via IV fluids
Zolendronic acid
What is Zolendronic acid?
SC biphosphate
quicker acting than alendronic acid
How can skeletal related events be avoided?
Denusumab
What is the mechanism of action of Denosumab?
A monoclonal antibody for RANKL. This leads to the inhibition of osteoclast activity
SE - hypocalcaemia and osteonecrosis of the jaw?
What drugs can cause osteonecrosis of the jaw?
Denosumab
Zenodronic acid
What are Breslow and clark scales?
Staging systems to describe how deap melonama is from the epidermis
What conditions may be exacerbated by immunothearpy?
Autoimmune conditions
What is Gardasil?
HPV vaccine
Who is eligable for a HPV vaccine?
12-13 year old females
Who is screened for cervical cancer?
Ages 25-49 every 3 years every 5 years until 64 years old
Where in the lungs is small cell lung cancer located?
Centrally
Where in the lungs is squamous cell lung cancer located?
centrally
Where in the lungs is adenocarcinoma located?
Peripherally
Which lung cancer is most common in non smokers?
adenocarcinoma
Which type of lung cancer grows slowly?
adenocarcinoma
Which type of lung cancer tends to metastesis early?
Adenocarcioma
Which lung cancer has the best survival?
Squamous cell carcinoma as it is potentially operable
Which type of lung cancer are tyrosine kinase inhibitors used for?
adencarcinoma
Cancer patient present with new onset confusion, what investigation should be used?
MRI - brain mets
Blood test - Ca2+
What medication should be given for brain mets?
8mg dexamethasone BD PO
What Symptoms are there for SVC obstruction?
dilated veins on upper chest
red eyes
SOB worse when lying down
Arm swelling
A patient with lung cancer has a hoarse voice, what does this indicate?
Laryngeal nerve involvement and therefore mediastinal involvement by the lung cancer
What type of biopsy is used for hodgkins lymphoma?
Excisional biopsy
What is good clinical practise in relation to clinical trials?
nternationally-recognised ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.
What type of hodgkins lymphoma can have a asymptomatic relapse?
Nodular lymphoid predominant
Doxorubicin is a cytotoxic chemotherapy agent used in hodgkins lymphoma. What is its common side effect?
cardiotaxic
What is the fitzpatrick scale?
A scale from 1 to 5 which classifies responce to UV
What side effects does cisplatin have?
Bone marrow supression
Peripheral neuropathy
Hearing impairment
Renal impairment
Not hair loss
How is chemotherapy usually dosed?
By body area due to GFR
What genetic mutation is tested for in melanoma?
BRAF v600
What is the treatment for BRAF v600 positive melanoma?
Combination of BRAF and MEK inhibitor immunotherapy
What do MEK and BRAF have in common?
They are both part of the same signalling pathway.
Also both immunotherapies can used with no increase in toxicities to stop metastesis of the melanoma.
What biochemical indicators are there for testical cancer?
Teratomas can secret HCG and AFP
Human chorionic gonadotropin
Alpha fetal protien
top three cancers in men
- prostate2. lung3. colorectal
top three cancers in women
breastlungcolorectal
common sites for mets
lung, bone, brain, liver
Most common type of paraneoplastic syndrome in lung cancer
SCC- hypercalcaemia due to PTrH, HPOA
things need to know before performing CT with contrast
previosu contrast reactionrenal functiondiabetes- metformin might need to be stopped
small cell cancers lung
smoking relatedrapid growthnot curable
sqamous cell carcinomas lung
smoking relatedusually operable
adenocarcinoma- lung
mets earlynon smokerperipheral location
Ct scan reveals brain mets- immediate treatment
dexamethasone
signs of superior vena cava obstruction
ref suffsed eyesSOB on lying downdilated veins in upper chestswelling of arm
treatment for metastatic spinal cord compression
high dose dexamethasoneneurosurgical stabilisation, opioid analgesiamaybe radiotherapy
Red flags in back pain
pain in thoracic spinepain at rest and on movementweight losship weaknessurinary retention
Treat hypercalcaemia
bisphosphonates, denosumab, fluids and diuretics, prednisone
HPV strains in vaccine
16 and 18- cancer related6 and 11- warts
cervical screening
starts age 25, invited every 3 years until 4950-64- 5 yearly
cisplatin toxicity
hearing impairmentperipheral neuropathyrenal impairmentbone marrow suppression
chemotherapy typically dosed according to what
body surface area
reed sternburg cells
hodgkins lymphoma
smudge cells
CLL
