Oncology

Question 1

Chemo: List Alkylating agents and side effects

Answer 1

Cyclophosphamide: haemorrhagic cystitis, bladder cancer, infertility, SIADH-like, lymphopaenia, Cardiotoxicity if given as part of bone marrow transplant (large dose)

Ifosfamide: nephrotoxicity (tubular), neuro, reversible encephalopathy (can give methylene blue)

Temozolamide

Question 2

Chemo: List Anthracyclines and side effects

Answer 2

Doxurubicin, Epirubicin, Mitoxantrone
AE: Cardiomyopathy (irreversible and dose-dependent, effect can be delayed for decades), infertility, bone marrow toxicity, Palmar plantar erythema (PPE), Blistering

Question 3

List Aromatase Inhibitors

Answer 3

Anastrazole, Letrozole, exemestane
Blocks peripheral synthesis of oestrogen
AE: Hot flushes, arthralgia, osteoporosis
Use in post-menopausal

Question 4

Bleomycin side effects

Answer 4

Pneumonitis (idiosyncratic, fatal in up to 2%) Higher risk in older/smoker/lung disease/CKD
Renal + skin

Question 5

Chemo: List platinum-based and side effects

Answer 5

All can have any of below
Carbo: most myelosuppressive
Cisplatin: most emetogenic/nephrotoxic (hypo Ca,K,Mg), hearing loss Oxaliplatin: most neurotoxic (PN)
Vesicant toxic

Question 6

Chemo: List pyrimidine inhibitors and side effects

Answer 6

Azacitadine (AML): myelosuppression
5FU synergistic with Folinic acid: mucositis, diarrhoea, PPE, coronary spasm (5FU) (dihydropyrimidine dehydrogenase (DPD) deficiency predicts intolerance - <1%, not routinely screened in Aus)
Capecitabine is a prodrug of 5FU: oral form, higher rate of toxicity
Cytarabine: cerebellar toxicity, encephalopathy, keratitis, mucositis
Gemcitabine: hepatotoxic, flu-like

Question 7

Adverse effects of tamoxifen

Answer 7

VTE, increased endometrial cancer risk

Inferior to aromatase inhibitors (but AI can’t be given pre-menopause)

Question 8

Chemo: List taxanes and side effects

Answer 8

Paclitaxel, docetaxel

AE: Peripheral neuropathy, PPE, bone marrow suppression, Vesicant toxic Use in lungs, ovarian, breast, prostate

Question 9

Chemo: List topoisomerase inhbitors and side effects

Answer 9

Irinotecan (CRC): cholinergic, NASH, increased toxicity polymorphism UGTIA1*28 Etoposide (SCLC, Lymphoma, Testicular Ca, AML, MM): myelosuppression, irritant, hypotension with rapid infusion

Question 10

Chemo: List Vinca alkaloids and adverse effects

Answer 10

Vincristine in R-CHOP NHL
Vinblastine in ABVD HL
AE: Headache, Blistering, Neuropathy

Question 11

What surveillance and risk reduction should someone with BRCA mutation have?

Answer 11

30-40 yrs - annual MRI, +/- US
40-50 yrs - annual MRI, +/- MMG, +/- US
>50 yrs - annual MMG +/- US

Consider bilat mastectomy (best if under 40yo)
Salpingo-oophorectomy from 35 after family complete

Question 12

CEA: Tumour marker association

Answer 12

Colorectal cancer (primarily)
- Monitor for oligometastatic recurrence
Breast cancer
Lung Cancer

Elevated in smoking, renal failure

Question 13

B-HCG: Tumour marker association

Answer 13

Germ cell cancer: Non-seminomatous Testicular/choriocarcinoma
Can be positive in seminomatous
Good monitoring and surveillance

Question 14

AFP: Tumour marker association

Answer 14

HCC, Non-seminomatous testicular cancer

Question 15

CA-125: Tumour marker association

Answer 15

Epithelial: Ovarian, Cervix, Endometrium
Sometimes GIT, breast

Elevated in CCF

Question 16

CA15-3: Tumour marker association

Answer 16

Breast cancer

Question 17

CA19-9: Tumour marker association

Answer 17

Hepatobiliary - Pancreas, gallbladder, cholagniocarcinoma

Question 18

PSA: Tumour marker association

Answer 18

Prostate cancer

May be diagnostic if extensive bony mets in male with high PSA

Question 19

Calcitonin: Tumour marker association

Answer 19

Medullary thyroid cancer

Question 20

Thyroglobulin: Tumour marker association

Answer 20

Follicular thyroid cancer

Question 21

Screening and risk reduction strategies in HNPCC

Answer 21

Colonoscopy every 1-2y from 25yo
Consider aspirin
Can consider colectomy
Hysterectomy after childbearing or from 40yo, consider salpingoophorectomy at time
2nd yearly gastroscopy from 30yo in family with gastric cancer or east asian ethnicity

Question 22

Screening and risk reduction strategies in FAP

Answer 22

Annual flexisig from 10-12yo till polyps then annual colonoscopy till colectomy
Colectomy in late teens
Annual surveillance of residual rectum
Gastroscopy from 25yo 5yrly depending on findings
NO aspirin

Question 23

Criteria for moderately increased CRC risk

Answer 23

• one first-degree relative with CRC diagnosed <55 years
• two second-degree relatives with CRC both diagnosed <55 years
• two first-degree relatives with CRC both diagnosed >55 years
• one first-degree relative and two or more second-degree relatives diagnosed with CRC all >55 years

Question 24

Screening guidelines for moderate and high risk of CRC

Answer 24

Moderate: FOBT second yearly from 40yo, colonoscopy 5 yearly from 50yo, consider aspirin from 50yo

High: FOBT second yearly from 35yo, colonoscopy 5 yearly from 45yo, consider aspirin from 45yo

Question 25

Criteria for highly increased CRC risk

Answer 25

- three or more first-degree or second-degree relatives with CRC, with at least one diagnosed <55 years - three or more first-degree relatives with CRC, all diagnosed >55 years

Question 26

Trastuzumab SEs

Answer 26

Cardiotoxicity- reversible | no CSF penetration

Question 27

TDM-1 SEs

Answer 27

thrombocytopenia