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Finals > Oncology > Flashcards

Oncology Flashcards

1
Q

3 most common cancers in men

A

Prostate
Lung
Colorectal

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2
Q

3 most common cancers in women

A

Breast
Lung
Colorectal

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3
Q

Which cancers have a chance of being cured by chemo even if they have metastasised

A

Some leukaemias
Some lymphomas
Testicular germ cell
Ovarian dysgerminoma

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4
Q

What is meant by adjuvant treatment

A

A treatment given after definitive treatment with an aim to increase the chance of cure/reduce the chance of relapse

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5
Q

What is meant by neoadjuvant treatment

A

Treatment given before the main treatment to shrink the cancer or improve the chances of cure

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6
Q

What is meant by palliative treatment

A

Therapy where the aim is to improve quality of life but where cure is not possible. Can include most cancer treatments (chemo, radio, surgery) as well as symptom management.

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7
Q

What is meant by radical treatment

A

Treatment where the aim is to cure/get rid of the disease

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8
Q

What is meant by concurrent therapy

A

When 2 or more therapies are given simultaneously e.g chemoradiation

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9
Q

Why is radiation given as a course (in fractions, with time in between)

A

To give the normal tissues time to recover while the cancer regresses

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10
Q

Early side effects of radiotherapy

A 
Fatigue
Pain flare
Oesophagitis
Pneumonitits
Skin reactions
Diarrhoea
Nausea
Cystitis
Raised ICP
Hair loss
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11
Q

Late side effects of radiotherapy

A

Fibrosis
Stricture
Osteonecrosis
Secondary malignancy

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12
Q

What is brachytherapy

A

Radiation that is given internally

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13
Q

What are the 3 main systemic treatments for cancer

A

Chemotherapy
Monoclonal antibodies
Tyrosine kinase inhibitors

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14
Q

How often is chemo typically given

A

For a few hours every 2-4 weeks in cycles

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15
Q

When and what is full blood count nadir

A

You are likely to be at higher risk between seven and 12 days after you have received each chemotherapy treatment – and possibly lasting up to one week, when your white blood cells are at their lowest numbers. This period of time is often called your nadir, meaning “lowest point.”

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16
Q

Routes of delivery for chemotherapy

A 
Peripheral IV
Central IV - jugular or PICC line
Oral
Intrathecal
Intra-vesicularr
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17
Q

What are the 3 main chemotherapy emergencies

A

Neutropenic sepsis
Chemotherapy hypersensitivity
Tumour lysis syndrome

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18
Q

When would you treat as neutropenic sepsis

A

Pyrexial and neutrophil count <1

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19
Q

Side effects of chemotherapy

A

Bone marrow - neutropenia, thrombocytopenia
GI - mucositis, nausea and vomiting, diarrhoea
Skin - alopecia, rash
Heart - HF, MU, angina
Lungs - pulmonary fibrosis
Kidney - renal impairment
Nerves - peripheral neuropathy, hearing loss
Infertility

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20
Q

Diagnosis of tumour lysis syndrome

A 
Hyperuricaemia
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Renal failure
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21
Q

How do monoclonal antibodies work for cancer

A

They flag the tumour cells for immune destruction, some also block tumour signalling

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22
Q

How do tyrosine kinase inhibitors work for cancer

A

Block overactive intracellular signal pathways of tumour cells

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23
Q

Post-chemo nausea and vomiting is classed as delayed if it comes on when

A

More than 24 hours after the start of treatment

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24
Q

Presentation of spinal cord compression

A

Pain
UMN signs below the level of compression
Sensory level
Bowel/bladder symptoms

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25
Q

If you suspect spinal cord compression, which medication should you start

A

Dexamethasone

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26
Q

Which measure of performance status is commonly used in oncology MDTs

A

ECOG scale

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27
Q

Describe ECOG scale 0

A

Fully active, able to carry out all pre-disease performance without restriction

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28
Q

Describe ECOG scale 1

A

Restricted in physically strenuous activity but ambulatory and able to carry out light work

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29
Q

Describe ECOG scale 2

A

Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about for over 50% of waking hours

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30
Q

Describe ECOG scale 3

A

Capable of only limited self care. Confined to bed/chair for over 50% of waking hours

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31
Q

Describe ECOG scale 4

A

Completely disabled and confined to bed/chair. No self-care

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32
Q

Describe ECOG scale 5

A

Deceased

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33
Q

Commonest paraneoplastic syndromes in lung cancer

A 
Hypercalcaemia due to SCLC producing PTrH
Hypertrophic osteoarthropathy (HPOA)
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34
Q

What questions about the patient would you need to ask before giving CT contrast

A

Any previous reactions to contrast
Renal function (GFR <40 is increased risk of contrast induced AKI)
DM - metformin may need to be withheld prior to scan

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35
Q

Lung cancer pre-treatment investigations

A 
Bloods - including serum calcium 
Pulmonary function tests
Staging CT scan with contrast
Bronchoscopy and biopsy
Consider PET CT
36
Q

If a lung cancer has invaded the mediastinum or has affected the carina, how does this affect treatment options

A

Inoperable

37
Q

If a lung cancer has EGFR mutation then which treatment is it likely to respond well to

A

Tyrosine kinase inhibitors

38
Q

Where is small cell and squamous cell lung cancer typically located

A

Centrally

39
Q

Which type of lung cancer has the best survival

A

Squamous cell carcinoma (due to operability)

40
Q

Where is lung adenocarcinoma typically located

A

Peripherally

41
Q

Which type of lung cancer can occur in non-smokers

A

Adenocarcinoma

42
Q

Types of lung cancer from most to least common

A

Adenocarcinoma
Squamous cell carcinoma
Small cell lung cancer
Large cell carcinoma

43
Q

Which type of lung cancer is most likely to respond to newer systemic agents such as tyrosine kinase inhibitors

A

Adenocarcinoma

44
Q

What does it mean if a lung cancer is;
M1a
M1b

A 
M1a = malignant effusion or separate tumour nondule
M1b = distant mets
45
Q

If a patient has brain mets + oedema which medication should you start

A

Dexamethasone

46
Q

What is DNAR being called now in some places

A

AAND - allow a natural death

47
Q

Suspected lung cancer - indications for 2 week wait referral

A

CXR suspicious changes
Age >40 with unexplained haemoptysis
Age >40 with unexplained 2 of (1 if smoker) - cough, fatigue, SOB, chest pain, weight loss, appetite loss
Age >40 with persistent/recurrent chest infection, finger clubbing, supraclavicular lymphadenopathy, persistent cervical lymphadenopathy, suspicious chest signs, thrombocytosis

48
Q

Name of the medication used to help stop smoking

A

Champix

49
Q

What is meant by non-mechanical back pain

A

Worse at rest

50
Q

ER positive breast cancer will respond to…

A

Anti-estrogen therapy such as Tamoxifen

51
Q

HER2 positive breast cancer will respond to…

A

Monoclonal anti-HER2 therapy such as Herceptin (Trastuzumab)

52
Q

Name of the team you refer cancer patients with suspected cord compression to

A

MSCC - metastatic spinal cord compression co-ordinator

53
Q

What is Letrozole used for

A

Acts to reduce estrogen levels (aromatase inhibitor) - used as an adjuvant treatment for ER positive breast cancer

54
Q

If women are in Letrozole what monitoring do they need

A

DEXA scans - risk of osteoporosis

55
Q

Features/symptoms suggestive of metastatic spinal cord compression

A 
Progressive spinal pain
Severe unremitting spinal pain
Spinal pain aggravated by straining - OB, coughing, sneezing, moving
Band-like pain
Localised spinal tenderness
Nocturnal spinal pain
Radicular pain
Limb weakness
Sensory loss
Bowel/bladder dysfunction
Thoracic or cervical pain
56
Q

Acute management of hypercalcaemia

A

Rehydration

IV Zoledronic acid

57
Q

What investigation needs to be done before starting a patient on Herceptin and at regular intervals while on it

A

Echocardiogram to assess LVEF - can affect cardiac function

58
Q

What is Denosumab used for

A

Reduced oncology ‘skeletal related events’ - cord compression, fractures
Long-term treatment of bone mets
Given as a subcutaneous injection every 4 weeks

59
Q

Investigation for suspected metastatic spinal cord compression

A

MRI whole spine

60
Q

In the context of melanoma what does Ta and Tb mean

A 
Ta = not ulcerated
Tb = ulcerated
61
Q

In the context of melanoma what do Na, Nb and Nc mean

A

Na - nodal micromets
Nb - nodal macromets
Nc - nodal mets in skin

62
Q

What 2 scales are used to describe how deeply a melanoma has gone into the skin

A

Clark scale - which layers affected

Breslow scale - depth in mm

63
Q

In TNM staging, was does a letter ‘p’ indicate

A

This stands for pathological stage. It means that doctors based the staging on examining cancer cells in the lab, after surgery to remove a cancer.

64
Q

What does the grade of a cancer refer to

A

How similar cells are to normal cells and how quickly they are dividing

65
Q

What does the differentiation of a cancer refer to

A

How well developed the cells are and how normal the tissue structure is

66
Q

What does the stage of a cancer refer to

A

How big the tumour is and whether it has spread

67
Q

Why do you have to check for immune related conditions (e.g. RA, psoriasis) before starting immunotherapy for cancer

A

It can make those diseases worse

68
Q

Which gene mutation associated with some melanomas means that targeted therapy (Dabrafenib) may work

A

BRAF V600

69
Q

Name of UK HPV vaccine

A

Gardasil

70
Q

Which strains of HPV does the vaccine protect against

A

HPV 16 and 18

71
Q

Which HPV types are associated with genital warts

A

HPV 6 and 11

72
Q

Who is the HPV vaccine offered to

A

Girls age 12-13

Catch up vaccination is available for girls up to age 18

73
Q

When is cervical screening offered

A

3 yearly 25-49

5 yearly 50-64

74
Q

What kind of lymph node biopsy is used in suspected lymphoma

A

Excisional node biopsy (not FNAC)

75
Q

Describe a phase 0 trial

A

Small group

Low dose treatment to check it isn’t harmful

76
Q

Describe a phase 1 trial

A

Small group

Finding out about side effects and what happens to the treatment in the body

77
Q

Describe a phase 2 trial

A

Medium group
Side effects
How well the treatment works

78
Q

Describe a phase 3 trial

A

Large group
Compares new treatment to current treatment
Usually randomised

79
Q

Describe a phase 4 trial

A

Finding out about long term benefits and side effects

80
Q

CA 125

A

Ovarian cancer

81
Q

CA 15-3

A

Breast cancer

82
Q

CA 19-9

A

Pancreatic cancer

83
Q

AFP is a tumour marker for

A

Hepatocellular carcinoma or teratoma

84
Q

CEA is a tumour marker for

A

Colorectal cancer

85
Q

Features of SVC obstruction

A 
Dyspnea
Swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
Headache - often worse in the mornings
Visual disturbance
Pulseless jugular venous distention

Finals (32 decks)

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