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YEAR 4 - CCC > Oncology > Flashcards

Oncology Flashcards

1
Q

What cancers is HPV associated with?

A

Cervical
Anal
Head and neck

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2
Q

What subtypes of HPV are cancerous?

A

HPV16 and HPV18

HPV16 produces E6 protein, which binds to and inactivates p53 protein leading to dysregulation of cell cycle and apoptotic pathways

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3
Q

What cancer is Epstein Barr Virus associated with?

A

non-Hodgkin’s lymphomas

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4
Q

What cancer is HTLV1 infection associated with?

A

T-cell lymphomas

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5
Q

What cancer is H. Pylori associated with?

A

MALT (mucosal associated lymphoid tissue) tumours

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6
Q

What is the 2nd commonest cancer?

A

Lung cancer

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7
Q

What are the different types of lung carcinoma?

A
  1. Small cell lung carcinoma
  2. Non-small cell lung carcinoma
    a) Squamous cell
    b) Adenocarcinoma
    c) Large cell carcinoma
    d) Adenocarcinoma in situ
  3. Mesothelioma
  4. Sarcoma
  5. Lymphoma
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8
Q

What is the most common lung carcinoma?

A

Adenocarcinoma is now the most common lung cancer (40%) - it used to be squamous cell lung carcinoma until the 80s

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9
Q

What does small cell lung cancer arise from?

A

Endocrine cells called Kulchitsky cells

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10
Q

What type of lung cancer is more aggressive?

A

Small cell lung cancer
Grows rapidly and is highly malignant
70% are disseminated at presentation
Metastasise earlier in their course so often cannot be treated by surgery

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11
Q

What gene mutations are commonly found in adenocarcinomas?

A

EGFR - 19 & 21 mutations
ALK - translocation
ROS1 - mutation

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12
Q

Which patients is the EGFR mutation more common in?

A

East Asians
Females
Non-smokers
Young patients

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13
Q

What are the main causes of lung cancer?

A

Smoking - 90%

Occupation - asbestos exposure, uranium mining, ship building, petroleum refining

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14
Q

How does lung cancer usually present in order of most common symptoms?

A

Cough - 80%
Haemoptysis - 70%
Dyspnoea - 60%
Chest pain - 40%

Weight loss, anorexia, lethargy
Recurrent pneumonia

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15
Q

How does an apical Pancoast tumour present?

A

Horner’s syndrome

Ptosis, miosis, anhidrosis
Hoarseness of voice

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16
Q

How can a mediastinal tumour present?

A

Hoarseness of voice due to recurrent laryngral nerve palsy

SVC obstruction

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17
Q

What types of lung cancer can cause paraneoplastic syndromes?

A

Small cell lung cancer

Squamous cell lung cancer - hypercalcaemia

Large cell cancer - gynaecomastia

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18
Q

Give examples of paraneoplastic syndromes and their relevant hormone

A

Excess ACTH - Cushing’s
Excess PTH - hypercalcaemia
Excess HCG - gynaecomastia
Excess ADH - SIADH

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19
Q

What are some skin manifestations of lung cancer?

A

Dermatomyositis
Herpes zoster
Acanthosis nigricans

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20
Q

What signs might be seen on inspection of the hands in lung cancer?

A

Clubbing
Anaemia - pale palmar creases
Pain in the wrist - hypertrophic pulmonary osteoarthropathy

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21
Q

On auscultation of the chest, what sounds would be heard in lung cancer?

A

Monophonic wheeze due to partial airway obstruction

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22
Q

What factors of the history, examination and investigations would indicate squamous cell carcinoma?

A

Cigarette smoking

Hypercalcaemia - they secrete PTH-related peptide

Bronchial obstruction - often found centrally, close to bronchi

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23
Q

What factors of the history, examination and investigations would indicate adenocarcinoma?

A

History:

  • Woman
  • Non-smoker
  • Asbestos exposure

Investigations:

  • EGFR, ALK, ROS1 mutations
  • Peripheral tumour
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24
Q

What might be seen on a chest x-ray in lung cancer?

A 
Nodule 
Hilar enlargement 
Consolidation
Pleural effusion
Lung collapse
Bony mets
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25
Q

If there is suspicion of lung cancer from a CXR, what following investigations should be carried out?

A

Sputum cytology
CT thorax for staging

Either:

  • CT guided biopsy
  • Navigation bronchoscopy if lesion cannot be reached by CT guided biopsy

PET scan to check for mets not seen on CT
Lung function tests to check suitability for lobectomy

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26
Q

What is the histopathology for small cell lung carcinoma?

A

Small blue oval-shaped cells
Absent nucleoli
Decreased cytoplasm

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27
Q

What is the TNM staging for lung cancer?

A

T1-4: tumour size and invasion

N1: same hemithorax as tumour
N2: nodes in mediastinum on same side as tumour
N3: lymph nodes on other side from tumour

M1a: mets to other lung; pleural/pericardial effusion
M1b: distant mets outside thorax
M1c: multiple mets in different organs

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28
Q

What is the mainstay treatment for small cell lung cancer?

A

Chemotherapy (SCLC is considered a systemic disease at diagnosis)

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29
Q

When is radiotherapy used in SCLC?

A

Adjuvant radiotherapy as primary treatment with chemo

Prophylactic cranial irradiation - brain mets are common so reducing those reduces risk of relapse

Palliative

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30
Q

What are the different options for treatment of non-small cell lung carcinoma?

A

Surgery – usually lobectomy but if severe consider bi-lobectomy/pneumonectomy

Radiotherapy – 3times/day for 12 days straight. 20% 5 year survival

Chemotherapy – neoadjuvant for radiotherapy or palliative

Immune therapy – 1st line alone or combined with chemo

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31
Q

What is the untreated life expectancy for SCLC? What does chemotherapy increase this to?

A

Untreated life expectancy = 2-4 months

Chemotherapy increases it to 12 months

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32
Q

What are the 2 main types of breast carcinoma?

A

Ductal carcinoma (85%) - epithelial lining of ducts

Lobular carcinoma (15%) - epithelium of terminal ducts of lobules

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33
Q

Which breast carcinoma is more infiltrative?

A

Lobular carcinoma - it can present similarly to gynaecological cancers

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34
Q

What genes are associated with increased risk of breast cancer and what chromosomes are they found on?

A

BRCA1 - Chr17

BRCA2 - Chr13

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35
Q

What risk factors associated with oestrogen exposure increase the risk of breast cancer?

A 
Early menarche
Late menopause
HRT use
Obesity (especially post-menopause) 
Nullparity 
First child after 30
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36
Q

Where is oestrogen produced?

A

Premenopausal women – oestrogen produced in ovaries

Postmenopausal women – synthesis in fat cells (adipose tissue), skin, liver, muscle, breast

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37
Q

What is the most common presentation of breast cancer?

A

Breast lump

Hard, painless lump with irregular margins
Fixed to skin/chest wall

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38
Q

What are other common presentations of breast cancer aside from breast lump?

A 
Breast pain
Skin changes - peau d'orange, skin dimpling
Nipple discharge
Nipple changes - paget's disease
Axillary lymphadenopathy
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39
Q

What causes peau d’orange?

A

Oedema due to lymphatic invasion from tumour

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40
Q

What questions are important to ask in a breast cancer history?

A
  • How long?
  • Skin/nipple changes?
  • Associated symptoms – discharge/pain?
  • Related to menstrual cycle?
  • Previous breast lumps?
  • Lumps under arm?
  • Family history
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41
Q

How do you investigate a suspected breast cancer?

A

Triple assessment

1) Examination - breast, axilla, supraclavicular fossa\
2) Radiology - mammogram, USS
3) Biopsy - fine needle aspiration, cytology, histology

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42
Q

What is the treatment of choice for localised disease in breast cancer?

A

Surgery

Either:

  • Wide local excision to remove lump
  • Mastectomy to remove breast
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43
Q

What is required in all breast cancer patients after conservative?

A

Adjuvant radiotherapy to residual breast tissue +/- lymph node areas

40 Grays in 15 fractions over 3 weeks
Reduces risk of local relapse by half

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44
Q

What determines the efficacy of endocrine therapy in breast cancer?

A

The presence of oestrogen and progesterone receptors (60%) because it blocks oestrogen action and production

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45
Q

What endocrine therapy is only useful in post-menopausal women?

Why?

A

Aromatase inhibitors (anastrozole, letrozole)

They stop oestrogen production by blocking the action of aromatase enzyme which converts cholesterol to oestrogen in fat cells

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46
Q

What are some side effects of aromatase inhibitors?

A 
Mood changes
Vaginal dryness
Loss of libido
Arthralgia
Myalgia
Decreased bone density
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47
Q

What endocrine therapy is only useful in pre-menopausal women?

A

Ovarian ablation

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48
Q

What endocrine therapy can be used in pre- and post-menopausal breast cancer patients?

A

Tamoxifen

Selective oestrogen receptor blocker

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49
Q

What is the risk with tamoxifen?

A

Endometrial cancer - warn patient about abnormal vaginal bleeding

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50
Q

What is HER-2?

What is its relation to breast cancer?

A

HER-2 is an endothelial factor receptor oncoprotein that allow rapid multiplication of the cell

15% breast cancers overexpress HER-2

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51
Q

What drug can be used in HER2 positive breast cancers?

A

Herceptin = transtazumab (monoclonal antibody)

Give for 12 months

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52
Q

What is a risk of herceptin?

A

Cardiotoxicity
i.e. it makes the heart baggy
It is reversible

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53
Q

Which breast cancers are most responsive to chemotherapy?

A

ER-negative

HER2-positive

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54
Q

What chemotherapy drugs are typically used in breast cancer?

A

EC (epirubicin + cyclophosphamide) for 3 cycles
Docetaxel for 3 cycles

(if no lymph nodes involved, only EC for 6 cycles)

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55
Q

What chemotherapy agents can be given for ER positive breast cancers?

A

CDK4/6 inhibitors

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56
Q

What are some poor prognostic indicators in breast cancer?

A 
Triple negative 
HER2 positive
High TNM stage
Lymph node involvement
>5cm mass
Higher grade
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57
Q

What are 95% of prostate cancers?

A

Adenocarcinomas of glandular tissue in posterior/peripheral zone

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58
Q

Where do prostate carcinomas most common metastasise to?

A

Bone - especially spine

Lymph nodes

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59
Q

What genes increase risk of prostate cancer?

A

BRCA2

pTEN

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60
Q

What urinary symptoms might be seen in prostate cancer?

A

Decreased flow
Hesitancy
Frequency
Nocturia

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61
Q

Describe how the prostate feels on DRE in prostate cancer

A 
Hard
Enlarged
Irregular/craggy
Nodular 
Obliteration of median sulcus
Immobile
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62
Q

What scale is used for grading of prostate cancer?

A

Gleason’s Pattern Scale

A pathologist looks at prostatic tissue under microscope and grades the morphology of the cells from 1 to 5

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63
Q

What investigation is done to diagnose prostate cancer?

A

Trans rectal ultrasound of prostate (TRUS) + biopsy - diagnostic

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64
Q

When should you avoid treatment in prostate cancer?

A

If it is asymptomatic

In patients where other conditions are more likely to kill

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65
Q

What surgery can be done for prostate cancer?

A

Robotic radical prostatectomy

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66
Q

What patients is surgery a better option for in prostate cancer?

A

Patients with localised disease and are symptomatic and have >10 year life expectancy

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67
Q

What risks are there with a prostatectomy?

A

Impotence

Urinary incontinence

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68
Q

What hormone therapies can be used in prostate cancer? (5)

A

1) Luteinising hormone release hormone (LHRH) aka GnRH agonists – interferes with release of gonadotrophins from pituitary so decreases testosterone -Need to cover initially with anti-androgen (cyproterone acetate) to prevent rise in testosterone
2) Gonadotrophin releasing hormone antagonist
3) Anti-androgens – compete with androgens at androgen-receptor
4) Oestrogen therapy
5) Bilateral orchidectomy (castration)

69
Q

What are some side effects from hormone therapy in prostate cancer?

A 
Impotence
Loss of libido 
Tumour flare on initiation of treatment
Loss of muscle
Penis shrinkage
70
Q

What chemotherapy is most commonly used in prostate cancer?

A

Docetaxel

71
Q

When is hormone therapy used in prostate cancer?

A

Advanced metastatic disease

Neoadjuvant to surgery

72
Q

Describe the pathophysiology of colorectal cancer

A

Normal epithelium > hyperproliferative epithelium > benign adenoma > severe dysplasia (pre-cancerous polyp) > adenocarcinoma > invasive cancer

73
Q

What type of carcinoma are most colorectal cancers? What are some rarer types?

A

95% adenocarcinoma

Carcinoid
Gastrointestinal stromal tumour
Primary malignant lymphoma

74
Q

What dietary factors increase risk of colorectal cancer?

A

Rich in animal fats + meat

Poor in fibre - less fibre prolongs transit time so colon is more exposed to carcinogens present in faeces (bile salts can be carcinogenic either directly or when degraded by bacteria present in faeces)

75
Q

What genetic factors can increase risk of colorectal cancer?

A

HPNCC (a.k.a Lynch Syndrome)
FAP (familial adenomatous polypoposis)
Gardner’s syndrome

76
Q

How does left sided colorectal cancer present?

A

Early change in bowel habit
Rectal bleeding with mucus
Tenesmus
Obstruction (left colon is narrower and doesn’t expand as easily)

77
Q

How does right sided colorectal cancer present?

A

Weight loss
Iron deficiency anaemia
Abdominal pain
More advanced at presentation

78
Q

What are the red flags for colorectal cancer?

A 
Weight loss
Blood in stools
Change in bowel habit
Abdominal pain
Mucous in stools
Anorexia
79
Q

What is the screening programme for colorectal cancer?

A
  1. All 55+ are invited for one off flexible sigmoidoscopy
  2. All 60-74 year olds sent home test every 2 years
  3. Over 75s can ask for home test every 2 years
80
Q

What investigations can be done for suspected colorectal cancer?

A

Colonoscopy + biopsy

CT colonography (combines CT scanning with insufflation of whole colon with gas, which can help identify synchronous polyps in bowel) – staging

81
Q

What staging criteria is used for colorectal cancer?

A

Dukes Staging

A – confined to bowel wall
B – invasion through bowel wall
C – lymph node involvement
C1 – apical/high tide node is clear
C2 – apical node involvement 
D – widespread metastases
82
Q

What treatment can be curative in colorectal cancer?

A

Radical resection

83
Q

What treatment is not routinely used in colon cancer?

A

Radiotherapy due to risk of toxicity to adjacent organs

84
Q

What therapy is used in medium risk rectal cancers?

A

Radiotherapy (adjuvant + neoadjuvant)

85
Q

What therapy is used in high risk rectal cancers?

A

Chemotherapy (adjuvant + neoadjuvant)

86
Q

What presentation defines neutropenic sepsis?

A

Neutrophil count < 0.5
AND EITHER
Single temp > 38.5 OR sustained temp > 38 for 1 hour

87
Q

What microorganism are most neutropenic sepsis cases caused by?

A

Gram positive bacteria e.g. S. aureus, coagulase negative staph, alpha & beta haemolytic strep

88
Q

What is the main risk factor for neutropenic sepsis?

A

Chemotherapy (especially within 6 weeks of receiving chemo)

89
Q

What is the management for neutropenic sepsis?

A

BUFALO

Blood cultures 
Urine output - put catheter in
Fluids 
Antibiotics - start broad spectrum within an hour of admission 
(piperacillin/tazobactam) 
Lactate
Oxygen
90
Q

What can you give to a patient with severe neutropenia (neutrophils < 0.1) and multi-organ failure?

A

Colony stimulating factors e.g. filgratim/lenograstim

They are haematopoietic growth factors that promote stem cell proliferation and shorten duration of neutropenia

91
Q

What is the MASCC score?

A

Assesses risk of complications during febrile neutropenic episode

92
Q

What cancers are spinal mets most commonly associated with?

A 
Lung
Prostate
Breast 
Breast 
Myeloma 
Melanoma
93
Q

What causes spinal cord compression?

A

Collapse or compression of vertebral body due to mets

OR

Direct extension of a tumour into vertebral column

94
Q

How does spinal cord compression present?

A

Back pain (95%) exacerbated by movement, coughing and lying flat
Limb weakness
UMN/LMN signs depending on level of compression

95
Q

How do you investigation a spinal cord compression?

A

Full spine MRI
Neurological examination
PR to assess sphincter tone

96
Q

What is the acute management for spinal cord compression?

A

Dexamethasone 16mg + PPI (make sure to measure glucose)

MRI of spine

Refer to oncologists/neurosurgeons

97
Q

What further management can be done in spinal cord compression?

A

Radiotherapy

Decompressive surgery (if there has been mechanical collapse of vertebra)

98
Q

What is the prognosis of spinal cord compression?

A

If treated within 24 hours, 57% will be able to walk again

Patients with loss of motor function after >48h are unlikely to recover function

99
Q

How does cauda equina syndrome present?

A 
Back pain
Radicular pain down legs
Asymmetrical, atrophic, areflexic, flaccid paralysis of legs
Saddle anaesthesia
Decreased sphincter tone
100
Q

What is the normal physiological process if there is high blood calcium level?

A

High calcium causes thyroid to release calcitonin
Calcitonin reduces absorption of calcium in kidneys
It also promotes osteoblasts to deposit calcium in bones

101
Q

What is the normal physiological process if there is low blood calcium level?

A

Low calcium causes parathyroid gland to release PTH
PTH stimulates kidneys to absorb calcium
PTH causes kidneys to convert 25-hydroxy vitamin D to 1-25 dihydroxy vitamin D, which stimulates bowels to absorb calcium
PTH promotes osteoclasts to release calcium from bones

102
Q

What is the most common cause of hypercalcaemia?

A

Primary Hyperparathyroidism

103
Q

What cancers most commonly cause hypercalcaemia?

A 
Non-small cell lung carcinoma
Multiple myeloma
Breast carcinoma
Renal cell carcinoma
Head + neck cancers
104
Q

What blood results would indicate hypercalcaemia of malignancy rather than primary hyperparathyroidism?

A 
Low albumin
Low chloride
Alkalosis
Low potassium
High phosphate
High ALP
105
Q

How do you manage hypercalcaemia?

A
  1. IV 0.9% saline 1L every 4 hours for 24h then every 6 hours for 48-72h
  2. Zolendronic acid 4mg IV or IV pamidronate
  3. Salmon calcitonin (S/C or IM) and corticosteroids (prednisolone PO)
106
Q

What medication should you avoid in hypercalcaemia?

A

Thiazide diuretics

107
Q

What can cause a high ALP with hypercalcaemia?

A

(higher bone turnover)

  • Bone metastases
  • Sarcoidosis
  • Thyrotoxicosis
  • Lithium
108
Q

What most commonly causes superior vena cava obstruction?

A

Extensive lymphadenopathy in upper mediastinum from lung cancer or lymphoma

109
Q

What are some possible benign causes of SVCO?

A
  • Non-malignant tumours e.g. goitre
  • Mediastinal fibrosis e.g. post-radiotherapy
  • Infection e.g. TB
  • Aortic aneurysm
  • Thrombus associated with indwelling catheters
110
Q

How does superior vena cava obstruction present?

A 
Symptoms
• Headache/feeling of fullness in head 
• Facial/upper limb oedema
• Dyspnoea – worse on lying flat
• Cough
• Hoarse voice

Signs
• Oedematous face/neck
• Dilated veins in neck, chest, arms
• Stridor

111
Q

How would brachiocephalic artery obstruction present?

A

Arm swelling

112
Q

What is the management of SVCO?

A

Dexamethasone 16mg + PPI

Further options:

  • vascular stenting
  • radiotherapy
  • chemotherapy
  • LMWH (if thrombus confirmed)
113
Q

What tumour markers are associated with germ cell/testicular cancers?

A

Alpha fetoprotein (aFP)

hCG

114
Q

What benign conditions are relevant to aFP?

A

Liver cirrhosis
Pregnancy
Neural tube defects

115
Q

What cancer is relevant to calcitonin?

A

Medullary thyroid

116
Q

What cancer is relevant to CA-125?

A

Ovarian

117
Q

What conditions is CA-125 low in?

A

Endometriosis

PID

118
Q

What cancer is relevant to CA19-9?

A

Pancreatic

119
Q

What use does measuring CA19-9 have in pancreatic cancer?

A

Monitoring the disease only

120
Q

What tumour marker is associated with breast cancer?

A

CA15-3

121
Q

What tumour marker is associated with colorectal cancer?

A

CEA

122
Q

What else is CEA raised in?

A

Smoking
CKD
Chronic liver disease
IBD

123
Q

What tumour marker is the most sensitive to the disease?

A

PSA in prostatic carcinoma

124
Q

What cancer do raise immunoglobulins suggest?

A

Myeloma

125
Q

What are tumour markers?

A

Substances produced either by, or in response to, tumour and are present in the blood or other tissue fluids and can be quantified

126
Q

What other cancer is aFP raised in?

A

Hepatocellular cancer

127
Q

What are UMN signs?

A

Hypertonia
Hyper-reflexia
Upgoing plantars

128
Q

What type of scan is a PET scan?

A

Nuclear imaging that uses fluorodeoxyglucose (FDG) as a radiotracer
This allows a 3D image of metabolic activity to be generated using glucose uptake as a proxy marker

129
Q

What is Pemberton’s sign?

A

Ask patient to raise their arms until they touch the side of their face
If they develop cyanosis, worsening of their shortness of breath or facial congestion, it is positive for venous congestion

130
Q

How does ovarian cancer often present?

A

Non-specific abdominal symptoms
E.g.
- Bowel disturbance
- Abdominal distention and discomfort

131
Q

What is the most common origin of bony mets?

A

In men: prostate

In women: breast

132
Q

What cancer are women who have HNPCC at risk of other than colorectal cancer?

A

Endometrial cancer

133
Q

What is Li-Fraumeni syndrome caused by?

A

Germline mutations to p53 tumour suppressor gene

134
Q

What malignancies is Li-Fraumeni syndrome particularly associated with?

A

Sarcomas - it is diagnosed when an individual develops sarcoma under 45 years
Leukaemias

135
Q

What kind of bone lesions are most common in prostate cancer and myeloma?

A

Prostate cancer - sclerotic bone lesions

Myeloma - lytic bone lesions

Therefore, myeloma often causes hypercalcaemia, whereas prostate cancer does not

136
Q

What is the dose of radiation defined as in radiotherapy?

A

Irradiation absorbed by each kilogram of tissue expressed as Grays (Gy)

1 Gy = 1J/kg

137
Q

Briefly summarise how radiotherapy works

A

X-Rays have very high energy and very short wavelength (they deliver energy through photons), which are produced by accelerating a stream of electrons and colliding them with a metal targets

The X-Rays are generated and delivered by a linear accelerator (LINAC)

High-energy photons produce secondary electrons in human tissue (whilst sparring the skin), causing DNA damage and leads to apoptotic or mitotic cell death

138
Q

What is a fraction (in radiotherapy)?

A

One treatment session of radiotherapy

139
Q

What is the most common method to deliver radiotherapy?

A

External beam radiation therapy

This can be:

  • Image-guided radiotherapy = CT/MRI is used to target tumours while minimising radiation exposure of healthy tissues
  • Stereotactic radiosurgery (e.g. gamma knife) = multiple radiation beams converge on the tumour e.g. brain tumours
140
Q

What is the most common acute adverse effect of radioetherapy?

A

General fatigue - 80% patients

141
Q

What is a common complication after head/neck irradiation, particularly if the parotids have been irradiated?

A

Loss of salivary flow leading to dry mouth

142
Q

In radiotherapy, what does fractionating mean? What is the purpose of it?

A

A course of radiotherapy is spread over days or weeks.

Fractionating allows normal tissues to repair from the radiation damage, while tumour cells, which are less efficient to repair, do not recover

143
Q

In radiotherapy, what is a beam of radiation called?

A

A field

144
Q

Which tissues are most acutely damaged by radiotherapy?

A

Fast proliferating tissues

e. g.
- Skin
- Mucosa of GI tract
- Hair
- Bone marrow

145
Q

Generally, what is the mechanism of action of chemotherapy?

A

Most agents target DNA either directly or indirectly

Therefore, chemo agents are preferentially toxic towards actively proliferating cells

146
Q

How are chemotherapy doses calculated?

A

According to the patient’s body surface area
Most commonly used formula is DuBois formula

Carboplatin dose is calculated from renal function

Monoclonal antibody dose is calculated based on body weight

147
Q

What acute/immediate complications can be experienced from chemotherapy agents?

A

Nausea/vomiting
Myelosuppression - neutropenia, anaemia, thrombocytopenia
Mucositis - aphthous ulcers, diarrhoea
Alopecia
Neuropathies - PNS (burning, tingling), ANS, CNS, ototoxicity
Acute arrhythmias
Transient rise of liver enzymes
Skin and soft tissue
- Palmar plantar erythema (hand-foot syndrome)
- Photosensitivity
- Nail changes - bow’s lines

148
Q

What long term complications can be experienced from chemotherapy agents?

A

Infertility
Pulmonary fibrosis or pneumonitis
Secondary malignancies
Cardiac fibrosis

149
Q

What is the screening programme for breast cancer?

A

Mammography

Ages 50-74yr every 3 years

150
Q

What patients with NSCLC may be offered immunotherapy?

A

Those with high PDL1 expression

A molecule involved in controlling the normal immune response

151
Q

What immuotherapy is offered to those with high PDL1 expression with NSCLC?

A

Pembrolizumab

152
Q

What % of NSCLC are suitable for targeted therapy?

A

<10%

153
Q

What investigations are done for prostate cancer?

A 
PR
PSA
Isotope radionucleotide bone scan
Urinalysis (haematuria)
TRUS
154
Q

When is a TRUS not performed in prostate cancer?

A

When clinical suspicion is high

eg PSA >100 with positive bone scan

155
Q

What isotope bone can is performed in prostate cancer?

A

Radiolabelled technetium

Taken up by osteoblasts at sites of bone remodelling eg sclerotic bone mets in prostate cancer

156
Q

Give two examples of LNRH agonist therapies used in prostate cancer

A

Leuprorelin

Goserelin

157
Q

How are LNRH agonist therapies given in prostate cancer treatment

A

Monthly or 3 monthly

IM or SC depot injection

158
Q

What are some side effects of NRH agonist therapies given in prostate cancer treatment?

A

Impotence
Loss of libido
Tumour flare

159
Q

When does tumour flare occur in LNRH agonist therapy given in prostate cancer treatment? How is it avoided?

A

Occurs on initiation of treatment prior to the down-regulation of gonadotrophin

Avoided by short term concomitant anti-androgen therapy

160
Q

What are some long term risks of LNRH agonists used for treating prostate cancer?

A

Cardiac risks

Osteoporosis

161
Q

Give an example of a GnRH antagonist used in the treatment of prostate cancer

A

Goserelin
Leuprorelin
Triptorelin

162
Q

How does oestrogen therapy work in prostate cancer?

A

Oestrogens inhibit LNRH production from hypothalamus

163
Q

Why is oestrogen therapy rarely used in prostate cancer?

A

Side effects

Impotence, loss os libido, gynaecomastia, MI, stroke, PE

164
Q

Give two examples of anti-androgen therapy used in the management of prostate cancer

A

Bicalutamide

Enzalutamide

165
Q

What can enzalutamide be combined with in the treatment of prostate cancer?

A

GnRH agonists

166
Q

What is the prognosis of prostate cancer?

A

Low risk = 99% 5yr survival

Metastatic disease = 3.5 yrs 5 median survival

167
Q

What suggests a poor prognosis in prostate cancer?

A

Bone mets
Aggressive pathology
Younger age

168
Q

What treatment is more suitable for elderly patients with prostatic carcinoma?

A

Radiotherapy

169
Q

What are the 2 methods of radiotherapy for prostatic carcinoma and what are the pros/cons?

A

External beam radiotherapy (high energy Xrays from outside body) - risk of impotence and proctitis

Brachytherapy (radioactive seeds planted in prostate) - less risk of impotence and bladder problems

YEAR 4 - CCC (7 decks)

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