Oncology

Question 1

Why is radiotherapy given as a course?

Answer 1

Normal tissue recovers faster than cancer tissue - giving as a course allows normal tissue time to recover

Question 2

Which type of lung cancer can cause hypercalcemia and why?

Answer 2

Squamous cell lung cancer
Due to paraneoplastic syndrome
Releases PTH which causes hypercalcemia

Question 3

What is performance status in regards to cancer treatment?

Answer 3

Tells how active a person is - the better the performance status then the better they will respond to certain cancer treatments

Question 4

What side effects are you likely to experience when having radiotherapy for lung cancer?

Answer 4

Oesophagitis - occurs within 2 weeks of beginning of treatment
Dyspnoea - due to lung damage

Note that the great vessels and the heart are relatively resistant to radiotherapy

Question 5

What must you always remember to prescribe and monitor when prescribing dexamethasone in cancer treatment?

Answer 5

PPI - as steroids can cause ulcers

Monitor BMs - as steroids can cause hyperglycaemia

Question 6

What is the 1 year survival for patients diagnosed with lung cancer in the UK?

Answer 6

30%

Question 7

Which type of lung cancer is more sensitive to chemotherapy?

Answer 7

Small cell lung cancer

Question 8

What is letrozole?

What do you need to monitor regularly when taking it?

Answer 8

Aromatise inhibitor
Used in treatment of breast and endometrial cancer
Reduces oestrogen levels

Must have DEXA scans - as it can cause risk of osteoporosis

Question 9

If you were in GP setting and you suspected MSCC, what would you do?

Answer 9

Urgent referral for MRI whole spine
Happens within 24-48 hours
Inform patient of concerns

Question 10

What blood tests would you do in a patient with MSCC and why?

Answer 10

FBC - as bone marrow infiltration can cause bone marrow supression with anaemia and thrombocytopenia
Bone profile - to look for hypercalcemia
U&Es - especially if hypercalcemia is found
LFTs - marker for other sites of metastatic disease

Question 11

Name some common bisphosphonates used in bone targeted cancer therapy?

Answer 11

Zoledronic acid

Denosumab - RANK ligand inhibitor

Question 12

What is an important side effect of bisphosphonates and how should patients be assessed to reduce risk?

Answer 12

Osteonecrosis of the jaw

Patients should have a dental assessment first prior to starting to reduce risk

Question 13

What does FDG mean on PET scan?

Answer 13

It means areas which are metabolically active and contain cancer

Question 14

What are immunotherapy agents used in cancer?

Answer 14

They are antibodies which help to activate the human immune system to help fight off cancer cells?

Question 15

Why might someone with an autoimmune condition be advised against immunotherapy in cancer?

Answer 15

As immunotherapy agents activate the immune system

This can worsen autoimmune conditions by activating the autoimmune pathways

Question 16

How are toxicities caused by immunotherapy managed?

Answer 16

Corticosteroids - these lessen the immune response

Question 17

What type of immunotherapy is used in some Melanomas?

Answer 17

BRAF inhibitors
These target a mutation in some types of melanoma
This leads to inactivation of the cancer cells

Question 18

What are the common side effects seen with immunotherapy?

Answer 18

Skin rash
Diarrhoea
Endocrinopathy
Hepatitis

Question 19

What types of HPV does the Gardasil vaccine cover against?

Answer 19

HPV 16 and 18 - cause 70% of cervical cancer

HPV 6 and 11 - cause genital warts

Question 20

What are the side effects of radiation to the pelvis in a female?

Answer 20

Can cause infertility - due to loss of ovarian function
Dry vagina - leading to problems with sexual dysfunction. Patients are advised to use lubricants
Vaginal stenosis - patients are advised to use dilators

Question 21

What is brachytherapy in cervical cancer?

Answer 21

Using a radioactive source which is inserted via an applicator into the vagina or cervix

As the radiation has a shorter range, a higher dose can be delivered with less toxicity to surrounding organs

Question 22

What is cisplatin?

Answer 22

A platinum agent used in cancer therapy

Causes DNA crosslinking which prevents DNA repair/synthesis

Question 23

What are the side effects of cisplatin?

Answer 23

Hearing impairment
Peripheral neuropathy
Bone marrow suppression
Renal impairment

Question 24

What key information must be given to a patient when discussing a clinical trial?

Answer 24

Details of trial
They can withdraw from it at any time
The standard therapy available if they don’t enter the trial
Entry to trial is voluntary and refusal won’t affect their care in any way
Any other information the patient considers necessary to make in informed decision