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Pass Medicine > Oncology > Flashcards

Oncology Flashcards

1
Q

What is multiple myeloma?

A

A neoplasm of the bone marrow plasma cells

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2
Q

Peak incidence for multiple myeloma?

A

60-70 years old

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3
Q

What are the clinical features of multiple myeloma?

A 
Bone disease - osteoporosis, osteolytic lesions (rain-drop skull x-ray with black drops in the skull)
Lethargy
Hypercalcaemia
Renal failure
Amyloidosis
Infection
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4
Q

Investigations for multiple myeloma?

A

Monoclonal proteins (IgG or IgA) in the serum and urine (Bence Jones proteins)
Increased plasma cells in the bone marrow
Skeletal survey for bone lesions (however we now use full body MRI)
X-ray - rain drop skull

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5
Q

Why is hypercalcaemia a feature in myeloma?

A

Due to increased osteoclastic bone resorption caused by local cytokines (Il-1, TNF) released by myeloma cells
Impaired renal function

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6
Q

Unexplained petechiae and hepatomegaly indicate?

A

Could indicate leukaemia

Refer for immediate assessment

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7
Q

What is Burkitt’s lymphoma associated with?

A

Epstein-Barr virus

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8
Q

What condition are thymoma’s commonly seen in?

A

Myasthenia gravis

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9
Q

What genes can predispose women to breast cancer?

A

BRCA1
BRCA2
These account for 10% of breast cancers

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10
Q

Risk factors for breast cancer

A

Prolonged oestrogen exposure (early menarche, late menopause, nulliparity)
HRT

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11
Q

Histology in breast cancer

A

Invasive ductal carcinoma (70%)

Invasive lobular carcinoma (30%)

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12
Q

Clinical presentation of breast cancer

A

Mass that is present throughout menstrual cycle
Nipple discharge (10%)
Pain (7%)

40% have axillary node disease

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13
Q

Common metastases sites breast cancer

A

Bone (70%)
Lung (60%)
Liver (55%)
Pleura (40%)

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14
Q

What is Paget’s disease of the nipple?

A

A rare form of breast cancer usually affecting the ducts of the nipple
Eczematous skin changes to the nipple/areola

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15
Q

Staging for breast cancer

A

TMN

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16
Q

Treatment of breast cancer

A

Spans from observation to prophylactic bilateral mastectomy

Axillary nodal excision as well

Adjuvant radiotherapy

Adjuvant hormonal therapy (if ER+ receptor expressed) - tamoxifen

Adjuvant chemotherapy (trastuzumab for HER2)

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17
Q

Prevention of breast cancer in high risk patients

A

Tamoxifen

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18
Q

Breast cancer screening

A

Mammographic screening (age 50-70, 2-3 yearly)

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19
Q

Types of lung cancer

A

Small cell lung cancer (20%)

Non-small cell lung cancer (80%)

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20
Q

Types of non-small cell lung cancer

A

Squamous (35%)
Adenocarcinoma (30%)
Large cell (10%)

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21
Q

Features of small cell lung cancer

A

Usually central
Arise from APUD cells (amine, precurosr uptake and decarboxylase cells)
Association with ectopic ADH and ACTH
Labert-Eaton syndrome - antibodies to calcium channels causing myasthenia gravis like syndrome

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22
Q

What features are caused by ectopic hormone production in small cell cancer?

A

ADH > hyponatraemia
ACTH > Cushing’s syndrome
ACTH > bilateral adrenal hyperplasia and thus high cortisol/hypokalaemic alkalosis

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23
Q

How do we manage small cell lung cancer

A 
Chemotherapy generally (due to likelihood of metastatic disease)
Etoposide or cisplatin

Median survival is 14 months

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24
Q

Squamous cell lung cancer

A

Normally central
Associated with PTH related protein secretion - causing hypercalcaemia
Finger clubbing
HPOA

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25
Q

Adenocarcinoma lung cancer

A

Typically peripheral - most common type in non-smokers
Gynaecomastia
HPOA

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26
Q

Large cell lung cancer

A

Peripheral
Anaplastic (poorly differentiated)
May secrete beta hCG

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27
Q

Non-small cell lung cancers

A

Develop from the epithelial cells anywhere from the central bronchi to the terminal alveoli

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28
Q

Non-small cell cancer treatment

A

Stages IIIa and less - complete surgical excision

Stages IIIb and IV - carboplatin or cisplatin

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29
Q

Investigating lung cancers

A

X-ray
CT - Ix of choice
Bronchoscopy - can allow biopsy
PET scanning - non-small cell cancers to determine viability of surgery

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30
Q

Surgery contraindications in lung cancer

A 
Stage IIIb or IV (metastases)
FEV1 <1.5L
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
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31
Q

Superior vena cava obstruction

A

Oncological emergency commonly associated with lung cancer

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32
Q

SVC obstruction symptoms

A 
Dyspnoea
Swelling of face, neck, arms
Headache
Visual disturbance
Pulseless jugular venous distension
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33
Q

Causes of SVC obstruction

A

Non-small cell cancers, lymphoma, breast cancer
Aortic aneurysm
Goitre

34
Q

Management of SVC obstruction

A

Dexamethasone
Balloon venoplasty
Stenting

35
Q

Lambert-Eaton syndrome

A

Associated with small cell lung cancer - an antibody against calcium channels
Repeated muscle contractions lead to increased muscle strength
Hyporeflexia
Autonomic symptoms: dry mouth, impotence, difficulty micturating
Ophthalmoplegia and ptosis not commonly seen

36
Q

Mesothelioma

A

Aggressive tumour of the surface serosal cells of the pleura, peritoneal and pericardial cavities

37
Q

Risk factors associated with mesothelioma

A

Asbestos (20-50 years before)

Smoking

38
Q

Symptoms associated with mesothelioma

A

Cough
Dyspnoea
Non-pleuritic chest wall pain

39
Q

Signs in mesothelioma

A

Usually there is dullness on one lung base + a pleural effusion seen on x-ray

40
Q

Mesothelioma x-ray findings

A

Thickened, nodular, irregular mass
Pleural plaques
Tumour often encompasses the whole lung, but rarely seen bilaterally
Moderate-large pleural effusion unilaterally also

41
Q

Colorectal cancer risk factors

A 
Strong relation to age (>60)
Diet: high calorie intake, red meat and alcohol intake
Smoking
Obesity
Inflammatory bowel disease
42
Q

What is HNPCC/lynch syndrome?

Hereditary non-polyposis colorectal cancer

A

Genetic syndrome of autosomal dominant pattern

Patients generally develop colorectal cancer in their 40s

43
Q

What is FAP?

Familial adenomatous polyposis

A

An inherited autosomal dominant pattern genetic condition.

Patients develop benign polyps which can progress into cancerous lesions

44
Q

Treatment for FAP

A

Prophylactic colectomy

45
Q

Pathophysiology of colorectal cancer

A

70% are adenocarcinomas arising in the mucosa from benign adenomatous polyps

46
Q

How do we stage colorectal cancer?

A

Duke’s staging:

A: tumour confined to mucosa
B: tumour has breached serosa
C: regional lymph nodes involved
D: Distant metastases present

47
Q

Treatment of colorectal cancer

A

Surgical - usually hemicolectomy
Radiotherapy (sometimes before the surgery to reduce its size)

5-fluorouracil/irinotecan regimens

48
Q

Prognosis of colorectal cancer

A

50% relapse within 2 years

49
Q

Colorectal cancer locations

A

Rectal - 40%
Sigmoid - 30%
Transverse/ascending - 15% ea.

50
Q

Colorectal cancer screening

A

60-74 year olds offer faecal immunochemical tests (FIT) every 2 years
If +ve result, colonoscopy

51
Q

Two categories of lymphoma

A

Hodgkin’s

Non-hodgkin’s

52
Q

Hodgkin’s lymphoma

A

Malignant proliferation of lymphocytes which accumulate in lymph nodes/other organs
M more affected than F
Peak incidence in 30s and 70s
Can be following EBV infection

53
Q

Clinical features of Hodgkin’s lymphoma

A 
Asymptomatic lymphadenopathy (usually above diaghram)
Fever
Night sweats
Weight loss
Alcohol pain
Chronic pruritus
54
Q

Pathophysiology of Hodgkin’s lymphoma

A 
Nodular sclerosing (60%)
Mixed cellularity (30%)
Lymphocyte predominant (5%)
Lymphocyte depleted (5%)
55
Q

In what condition do you see Reed-Sternberg cells

A

Hodgkin’s lymphoma

These are giant cells found with light microscopy, usually derived from B lymphocytes

56
Q

What might you find raised in Hodgkin’s lymphoma?

A 
Eosinophils
Lactate dehydrogenase (LDH)
57
Q

Which form of Hodgkin’s lymphoma has the worst prognosis?

A

Lymphocyte depleted

58
Q

How do we diagnose Hodgkin’s lymphoma

A

Biopsy of an enlarged lymph node (usually seeing Reed-Sternberg cells)

59
Q

Treatment of Hodgkin’s lymphoma

A

Radiotherapy if stage I-IIa
Stages IIb-IV - chemotherapy

Stem cell transplantation sometimes

60
Q

Chemo drugs for Hodgkin’s lymphoma

A 
ABVD
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
61
Q

Non-Hodgkin’s lymphoma

A

Malignant proliferation of lymphocytes

Does NOT contain Reed-Sternberg cells

62
Q

Risk factors for non-Hodgkin’s lymphoma

A

Elderly
Caucasian
History of viral infection (EBV)
FHx

63
Q

Clinical features of non-Hodgkin’s lymphoma

A

Painless lymphadenopathy

Fever, weight loss, night sweats, lethargy

64
Q

How can we differentiate between Hodgkin’s and non-Hodgkin’s lymphoma clinically?

A

Alcohol induced lymph node pain in Hodgkin’s lymphoma
B symptoms occur earlier in Hodgkin’s than in non-Hodgkin’s
Extra-nodal disease more common in non-Hodgkin’s

65
Q

What are ‘B’ symptoms?

A

Constitutional symptoms, e.g.

Weight loss, night sweats, fevers

66
Q

Investigations in non-Hodgkin’s lymphoma?

A

Excisional node biopsy

67
Q

Staging system for non-Hodgkin’s lymphoma

A

Ann Arbor system

68
Q

Ann Arbor system stages

A

Stage I - One node affected
Stage II - More than one node but same side of diaghram
Stage III - one node affected on either side of diaghram
Stage IV - extra-nodal involvement (e.g. spleen, bone marrow, CNS)

69
Q

Management of non-Hodgkin’s lymphoma?

A

Radiotherapy for stage I
Stages II-IV:
Oral chlorambucil, IV cyclophosphamide, vincristine + prednisolone

70
Q

Neutropenic sepsis

A

Commonly 7-14 days following chemotherapy

Defined as neutrophils <0.5 with temp >38 or other clinical symptoms of sepsis

71
Q

How can we prevent neutropenic sepsis

A

We give fluoroquinolones if we are anticipating patient to get a <0.5 neutrophil count

72
Q

Management of neutropenic sepsis

A

Give abx immediately (tazocin, piperacillin)

Vancomycin sometimes

73
Q

What is Burkitt’s lymphoma?

A

A high grade B cell neoplasm

74
Q

Two forms of Burkitt’s lymphoma?

A

Endemic (African) form: maxilla or mandible involvement

Sporadic: abdominal tumours (more common in patients with HIV)

75
Q

Microscopy appearance in Burkitt’s lymphoma

A

Starry sky appearance - lymphocyte sheets interspersed with macrophages and dead apoptic tumour cells

76
Q

Management of Burkitt’s lymphoma

A

Chemotherapy

77
Q

Tumour lysis syndrome

A

A condition related to treatment of lymphomas and leukaemias, usually following chemotherapy

Breakdown of tumour cells releases chemical into the body

78
Q

Electrolyte abnormalities with tumour lysis syndrome

A

Potassium high
Phosphate high
Calcium high
Uric acid high

79
Q

How do we treat tumour lysis syndrome?

A

IV allopurinol given before chemotherapy
Fluids
Dialysis if kidney failure is bad and other therapy has not worked

80
Q

Malignant spinal cord compression symptoms

A

Usually due to vertebral metastases, symptoms include:
Vertebral pain - esp. lying flat/coughing
Sensory changes two dermatomes below level
Motor weakness
Sphincter disturbance

81
Q

Treatment of malignant spinal cord compression

A

High dose dexamethasone

Surgical decompression/radiotherapy

Pass Medicine (24 decks)

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