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My Final Year 4 Revision > Oncology > Flashcards

Oncology Flashcards

1
Q

Welcome to oncology

A

“Big pharma has the cure for cancer”

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2
Q

How does radiotherapy treat cancer?

A

Breaks the double stranded DNA leading to cell death in all cells. Normall cells recover faster than cancerous cells.

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3
Q

What is a fraction when referring to radiotherapy?

A

A dose of radiothearpy

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4
Q

What the difference between palliative and radical radiotherapy?

A

Radical aims for cure and takes longer to plan.

Palliative aims to control symptoms and is quicker to plan (next day)

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5
Q

How can radiotherapy cause side effects?

A

Inflammation - acute

Fibrosis and scaring - chronic

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6
Q

What side effects of radiothearpy can be atributed to inflammation?

A

Fratigue

Pain flare from bones

Site dependent inflamation

D&V

raised ICP

skin irritation

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7
Q

What side effects of radiothearpy can be atributed to fibrosis?

A

Stricutres

Oesteonecrosis

Rib fractures

2nd malignancies

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8
Q

What is the main type of chemo thearpy?

A

Cytotoxic chemotherapy

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9
Q

What is the aim of adjuvant chemotherapy?

A

Stop relapse (via micro metastesis) after curative treatment

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10
Q

What is Neo-adjuvant therapy?

A

Treatment of tumour in order to reduce size or “buy time” for curative treatment

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11
Q

How can chemotharpy attenuate radiotherapy?

A

Chemothaerpy agenst like gemcitabine can increase radiotherapy effectiveness

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12
Q

What would chemotherapy side effects would be dose limiting (e.g: pause or reduce chemotherapy dose)?

A

Neutropenia

Thrombocytopenia

mucositis (GI tract)

D&V

alopecia

Peripheral neuropathy

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13
Q

What oncological emergencies are there?

A

Neutropenic sepsis

Tumour lysis syndrome

Spinal chord compression
Hypersensitivity

Superior vena cava obstruction

Malignancy associated hypercalcaemia

Brain mets

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14
Q

What is brachytherapy?

A

High dose radioactive source placed locally to the tumour. Often used uterus prostate

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15
Q

What is stereotactic radiotheraoy?

A

Highly acurate conventional external beam radiotherpy (ERBT) to target small tumours with precision (e.g: Gamma knife). Treatment of intacranial tumours

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16
Q

What is defined as neutropenic sepsis?

A

Temp > 38ºC

Neut count <0.5x10^9/L

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17
Q

What is the treatment neutropenic sepsis?

A

Sepsis within 1 hour

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18
Q

What is the Sepsis 6?

A

3 in:

IV fliuds

IV antibiotics

O2 (if < 94%)

3 out:

ABG for lactate

Cultures

Urine output

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19
Q

What is hypersensitivity

A

Anaphlyaxis after 2 or mre doses

Treat by stopping the offending drug then:

fliuds

Immunosupression -steroids and anti-histamines

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20
Q

What is tumour lysis syndrome?

A

Hyperureaemia

hyperkalaeima

hyperphsophateamia

potentially occompanying renal failure

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21
Q

What is the pathophysiology of tumour lysis syndrome?

A

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

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22
Q

How is Tumour lysis syndrome treated?

A

Prevention is better:

Allupurinol or Rusburicase

fluids

monitoring and ID at risk pt.

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23
Q

What is superior vena cava (SVC) syndrome?

A

Reduced venus return from head and neck due to tumour compression partially occluding the SVC

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24
Q

How is SVC syndrome treated?

A

Avoid hypoxia

Dexamethasone

Organise - SVC stenting or radiotherapy

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25
Q

What are the symptoms of spinal chord compression?

A

Pain which radiates from back to front - nocturnal worse on straining

UMN signs - neuro defecit, sesory loss, ataxia

Bladder or bowel symptoms

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26
Q

How is spinal chord compression treated?

A

Dexamethasone - PPI

MRI spine

Radiolotherapy within 24 hours

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27
Q

What is ECOG?

A

A performance score form 0 to 5

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28
Q

What is ECOG score 3?

A

> 50% of day in bed or chair

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29
Q

What is ECOG 2?

A

< 50% of day in chair or bed

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30
Q

What cancer can HPV cause?

A

Cervical

Head and neck

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31
Q

What is Li-Fraumeni syndrome?

A

TP53 mutation leading to muiltiple early cancers

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32
Q

What is would be shown in the blood test for malignancy associated hypercalcaemia?

A

Raised calcium (inc. corrected), ALT and urea

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33
Q

How is oncologically related hypercalcaemia treated?

A

Dilution and dieresus via IV fluids

Zolendronic acid

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34
Q

What is Zolendronic acid?

A
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35
Q

SC biphosphate

quicker acting than alendronic acid

A
36
Q

How can skeletal related events be avoided?

A

Denusumab

37
Q

What is the mechanism of action of Denosumab?

A

A monoclonal antibody for RANKL. This leads to the inhibition of osteoclast activity

SE - hypocalcaemia and osteonecrosis of the jaw?

38
Q

What drugs can cause osteonecrosis of the jaw?

A

Denosumab

Zenodronic acid

39
Q

What are Breslow and clark scales?

A

Staging systems to describe how deap melonama is from the epidermis

40
Q

What conditions may be exacerbated by immunothearpy?

A

Autoimmune conditions

41
Q

What is Gardasil?

A

HPV vaccine

42
Q

Who is eligable for a HPV vaccine?

A

12-13 year old females

43
Q

Who is screened for cervical cancer?

A

Ages 25-49 every 3 years every 5 years until 64 years old

44
Q

Where in the lungs is small cell lung cancer located?

A

Centrally

45
Q

Where in the lungs is squamous cell lung cancer located?

A

centrally

46
Q

Where in the lungs is adenocarcinoma located?

A

Peripherally

47
Q

Which lung cancer is most common in non smokers?

A

adenocarcinoma

48
Q

Which type of lung cancer grows slowly?

A

adenocarcinoma

49
Q

Which type of lung cancer tends to metastesis early?

A

Adenocarcioma

50
Q

Which lung cancer has the best survival?

A

Squamous cell carcinoma as it is potentially operable

51
Q

Which type of lung cancer are tyrosine kinase inhibitors used for?

A

adencarcinoma

52
Q

Cancer patient present with new onset confusion, what investigation should be used?

A

MRI - brain mets

Blood test - Ca2+

53
Q

What medication should be given for brain mets?

A

8mg dexamethasone BD PO

54
Q

What Symptoms are there for SVC obstruction?

A

dilated veins on upper chest

red eyes

SOB worse when lying down

Arm swelling

55
Q

A patient with lung cancer has a hoarse voice, what does this indicate?

A

Laryngeal nerve involvement and therefore mediastinal involvement by the lung cancer

56
Q

What type of biopsy is used for hodgkins lymphoma?

A

Excisional biopsy

57
Q

What is good clinical practise in relation to clinical trials?

A

nternationally-recognised ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.

58
Q

What type of hodgkins lymphoma can have a asymptomatic relapse?

A

Nodular lymphoid predominant

59
Q

Doxorubicin is a cytotoxic chemotherapy agent used in hodgkins lymphoma. What is its common side effect?

A

cardiotaxic

60
Q

What is the fitzpatrick scale?

A

A scale from 1 to 5 which classifies responce to UV

61
Q

What side effects does cisplatin have?

A

Bone marrow supression

Peripheral neuropathy

Hearing impairment

Renal impairment

Not hair loss

62
Q

How is chemotherapy usually dosed?

A

By body area due to GFR

63
Q

What genetic mutation is tested for in melanoma?

A

BRAF v600

64
Q

What is the treatment for BRAF v600 positive melanoma?

A

Combination of BRAF and MEK inhibitor immunotherapy

65
Q

What do MEK and BRAF have in common?

A

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.

66
Q

What biochemical indicators are there for testical cancer?

A

Teratomas can secret HCG and AFP

Human chorionic gonadotropin

Alpha fetal protien

67
Q
A
67
Q

top three cancers in men

A
  1. prostate2. lung3. colorectal
68
Q

top three cancers in women

A

breastlungcolorectal

69
Q

common sites for mets

A

lung, bone, brain, liver

70
Q

Most common type of paraneoplastic syndrome in lung cancer

A

SCC- hypercalcaemia due to PTrH, HPOA

71
Q

things need to know before performing CT with contrast

A

previosu contrast reactionrenal functiondiabetes- metformin might need to be stopped

72
Q

small cell cancers lung

A

smoking relatedrapid growthnot curable

73
Q

sqamous cell carcinomas lung

A

smoking relatedusually operable

74
Q

adenocarcinoma- lung

A

mets earlynon smokerperipheral location

75
Q

Ct scan reveals brain mets- immediate treatment

A

dexamethasone

76
Q

signs of superior vena cava obstruction

A

ref suffsed eyesSOB on lying downdilated veins in upper chestswelling of arm

77
Q

treatment for metastatic spinal cord compression

A

high dose dexamethasoneneurosurgical stabilisation, opioid analgesiamaybe radiotherapy

78
Q

Red flags in back pain

A

pain in thoracic spinepain at rest and on movementweight losship weaknessurinary retention

79
Q

Treat hypercalcaemia

A

bisphosphonates, denosumab, fluids and diuretics, prednisone

80
Q

HPV strains in vaccine

A

16 and 18- cancer related6 and 11- warts

81
Q

cervical screening

A

starts age 25, invited every 3 years until 4950-64- 5 yearly

82
Q

cisplatin toxicity

A

hearing impairmentperipheral neuropathyrenal impairmentbone marrow suppression

83
Q

chemotherapy typically dosed according to what

A

body surface area

84
Q

reed sternburg cells

A

hodgkins lymphoma

85
Q

smudge cells

A

CLL

My Final Year 4 Revision (16 decks)

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