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Finals Revision > Oncology > Flashcards

Oncology Flashcards

1
Q

What is thrombocytopenia?

A

Reduced platelet count < 150x10^9/L

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2
Q

Causes of thrombocytopenia

A

Chemotherapy, paraproteins (multiple myeloma), bone marrow infiltration (leukaemia, lymphoma, myeloma)

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3
Q

Presentation of thrombocytopenia

A

Epistaxis, bleeding gums, haemoptysis, haematemesis, haematuria, haematochezia, malaena, metromenorrhagia, PPH, bruising/petechiae/purpura

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4
Q

What is Ca27.29 a tumour marker for?

A

Breast cancer

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5
Q

What tumour marker can be used for breast cancer?

A

Ca27.29

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6
Q

What is CEA a tumour marker for?

A

Colorectal cancer

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7
Q

What tumour marker can be used for colorectal cancer?

A

CEA

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8
Q

What is Ca19-9 a tumour marker for?

A

Pancreatic + biliary tree cancer

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9
Q

What tumour marker can be used for pancreatic and biliary tree cancer?

A

Ca19-9

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10
Q

What is AFP a tumour marker for?

A

Hepatocellular carcinoma

Non-seminomatous germ cell cancer

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11
Q

What tumour marker can be used for Hepatocellular carcinoma?

A

AFP

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12
Q

What is Beta-hCG a tumour marker for?

A

Non-seminomatous germ cell cancer

Gestational trophoblastic disease

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13
Q

What tumour marker can be used for non-seminomatous germ cell cancer?

A

AFP + B-hCG

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14
Q

What is Ca125 a tumour marker for?

A

Ovarian cancer

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15
Q

What tumour marker can be used for ovarian cancer?

A

Ca125

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16
Q

Define screening

A

A process of identifying apparently healthy people who may be at increased risk of a disease

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17
Q

What is grading of a cancer?

A

The extent to which the neoplasm resembles its cell or tissue of origin

  • Well-differentiated- closely resembles, grows slowly
  • Poorly-differentiated- do not resemble, grows rapidly
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18
Q

Describe the TNM cancer staging system

A

Size and extent to which is had spread
T- tumour size
N- nodal status
M- metastatic disease (4: mets to distant organs)

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19
Q

What is the most common cancer in women?

A

Breast cancer

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20
Q

Types of breast cancer

A

Mostly ductal or lobular, also Paget’s

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21
Q

Risk factors for breast cancer

A 
BRCA1+2, TP53 mutation
Age, previous Hx breast ca, FH breast ca
Nulliparity/1st child>30, not breast-feeding
Early menarche/late menopause
Radiation to chest
HRT/COCP
Cirrhosis
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22
Q

Presentation of breast cancer

A

Lump in breast or axilla, mostly painless

Nipple change- discharge, retraction, inversion, bloody discharge

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23
Q

Differentials of breast lump

A 
Breast cancer
Fibroadenoma
Fat necrosis
Cysts
Breast abscess
Intraductal papilloma
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24
Q

What makes up the assessment of a breast lump?

A

Triple assessment:

  1. History and examination
  2. Imagine- mammogram/USS
  3. Biopsy- fine needle aspiration/core needle biopsy/excision biopsy/incisional
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25
Q

How is breast cancer staged/grouped?

A 
Sentinel lymph node biopsy
ER + Progesterone receptor status
HER2 status
CT/PET for mets
TNM
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26
Q

Management of breast cancer

A 
Radiotherapy
Hormonal- Premenopausal- Tamoxifen; Postmenopausal- Letrozole
HER-2 +ve- Trastuzumab (Herceptin)
ER+ve- Docetaxel
Chemotherapy, Surgery
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27
Q

Screening for breast cancer

A

Women aged 50-71 every 3 years

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28
Q

What is the most common cancer in men?

A

Prostate cancer

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29
Q

What is the most common type and location of prostate cancer?

A

Mostly adenocarcinomas from peripheral zone of the prostate

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30
Q

Name the 4 zones of the prostate

A

Transitional, Anterior, Peripheral and Central

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31
Q

Where are the most common sites of metastasis of prostate cancer?

A

Bone & Lymph nodes

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32
Q

Risk factors for prostate cancer

A

Age, Black Afro-Caribbean, Family history

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33
Q

What is the main differential of prostate cancer?

A

Benign Prostatic Hyperplasia

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34
Q

Presentation of prostate cancer

A

Lower urinary tract symptoms (LUTS)- weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency/incontinence, dysuria
UTI, haematuria, haematospermia, tenesmus

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35
Q

What is found on DRE in prostate cancer?

A

Hard irregular prostate, asymmetry, nodule within lobe, induration, lack of mobility, palpable seminal vesicles

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36
Q

Investigations of suspected prostate cancer

A

PSA
Transrectal prostate biopsy
TNM staging
Gleason grading

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37
Q

What grading system is used for prostate cancer?

A

Gleason grading 1-5

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38
Q

Management of prostate cancer

A 
Active surveillance
Surgery
Radiotherapy- external beam/brachytherapy
Cryotherapy
Chemotherapy- Docetaxel, Cabazitaxel
Hormonal- androgen deprivation
- LNRH analogue- eg goserelin
- Anti-androgen- eg Cyproteroneacetate
- Bilateral orchidectomy
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39
Q

What are the adverse effects of androgen deprivation therapy for prostate cancer?

A

‘Flare phenomenon’- hot flushes, sexual dysfunction, loss of libido, osteoporosis, gynaecomastia, fatigue

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40
Q

Oncology causes of stridor

A

Head/neck tumour, lung/upper GI tumour

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41
Q

How is stridor diagnosed?

A

Clinically

Can use upper airway visualisation/imaging (CT)

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42
Q

Management of stridor

A
  • O2
  • Dexamethasone 16mg OD
  • Urgent ENT review
  • Stenting/Tracheostomy
  • Radiotherapy
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43
Q

Definition of hypercalcaemia

A

Corrected calcium >2.6mmol/L

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44
Q

Causes of hypercalcaemia

A
  • With raised PTH- Hyperparathyroidism
  • With low PTH- bone mets, ectopic PTHrp (esp SCLC), drugs (thiazides, vit D, lithium), thyrotoxicosis, adrenal insufficiency, TB, sarcoidosis
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45
Q

ECG finding in hypercalcaemia

A

Prolonged QT

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46
Q

Management of hypercalcaemia

A

Immediate IV fluids
IV Bisphosphonates- Zolendronate/Pamidronate
Steroids
Denosumab if resistant to bisphosphonates
Treat underlying cause

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47
Q

What types of malignancy predispose to massive haemorrhage?

A

Head and neck tumours, lung/GI tumours with history of bleeding

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48
Q

How might massive haemorrhage present?

A

Rapid loss of consciousness

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49
Q

Management of massive haemorrhage

A

Stop anticoagulation
ABCDE if for treatment
Or dark towels, remain with patient, Midazolam 10mg stat

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50
Q

What is the most common type of brain tumour?

A

Brain metastases

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51
Q

Where do brain mets most commonly arise from?

A

Lung, breast, melanoma

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52
Q

Presentation of brain mets

A

Headache worse in morning/coughing, N&V, seizures, cognitive/behavioural symptoms, papilloedema, progressive focal neurology (diplopia, visual field defect, upper/lower limb defect)

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53
Q

What symptoms would specifically present in mets in..

  • frontal lobe;
  • parietal lobe?
A

Frontal- personality change

Parietal- Dysarthria

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54
Q

What investigation should be done in suspected brain mets?

A

Urgent MRI brain

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55
Q

Management of brain mets

A

Steroids

Surgery/chemo/radiotherapy

56
Q

What is the normal physiology of ADH production?

A

Hypothalamus –> posterior pituitary releases ADH in response to increased serum osmolality –> in kidneys water reabsorbs into blood stream –> increased urine osmolarity –> reduced plasma osmolality

57
Q

What is the aetiology of Syndrome of inappropriate ADH secretion (SiADH)?

A

Tumour cells may secrete ADH especially SCLC

This causes hyponatraemia

58
Q

Presentation of Syndrome of inappropriate ADH secretion (SiADH)

A

Depression, lethargy, N&V, headache, irritability, muscle cramps, weakness, ataxia, confusion, seizures, coma

59
Q

What neuro sign is often seen on examination of Syndrome of inappropriate ADH secretion (SiADH)

A

Impaired deep tendon reflexes –> pseudobulbar palsy

60
Q

What is needed for diagnosis of Syndrome of inappropriate ADH secretion (SiADH)?

A

Hyponatraemia
Low plasma osmolality
Inappropriately elevated urine osmolality
Urine sodium >40mmol/L with normal salt intake
Euvolaemia
Normal thyroid and adrenal function

61
Q

Management of Syndrome of inappropriate ADH secretion (SiADH)

A

Fluid restriction

Sodium replacement

62
Q

What is Tumour Lysis Syndrome?

A

Severe metabolic disturbance caused by abrupt release of large quantities of cellular components into the blood following rapid lysis of malignant cells

63
Q

What electrolyte abnormalities are seen in Tumour Lysis Syndrome?

A

Hyperuricaemia
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

64
Q

Risk factors for Tumour Lysis Syndrome

A

Haematological malignancies
Treatment-sensitive tumours
Renal impairment
Volume depletion

65
Q

Presentation of Tumour Lysis Syndrome

A

Onset 1-5 days post-chemo
Weakness, constipation, vomiting, abdo pain, paralytic ileus, seizures, gout
Cardiac arrhythmias: palpitations, chest pain, collapse
AKI: reduced urine output, lethargy, nausea

66
Q

Prevention of Tumour Lysis Syndrome

A

Low/intermediate risk- monitoring, hydration, allopurinol

High risk- Rasburicase (catalyses oxidation of uric acid to allantoin) + hydration

67
Q

Management of Tumour Lysis Syndrome

A

Prevention
Correct hyperkalaemia- IV calcium gluconate, IV insulin + dextrose, salbutamol nebs
Cardiac monitoring
Dialysis if severe

68
Q

How is performance status measured?

A

ECOG/WHO
0 = Normal function
1 = Light work, independent ADLs
2 = Limited function, up and about > 50% of waking hours
3 = Limited ADLs, in bed/chair > 50% of waking hours
4 = Bed bound
5 = Dead

69
Q

What are the hallmarks of cancer?

A
  1. Sustained proliferative signalling
  2. Evading tumour suppressors
  3. Activating invasion and metastasis
  4. Resisting cell death
  5. Inducing angiogenesis
  6. Enabling replicative immortality
70
Q

What are the enabling hallmarks of cancer?

A
  1. Dysregulating cellular energetics

2. Avoiding immune destruction

71
Q

What are the enabling characteristics of cancer?

A
  1. Genetic instability and mutation

2. Tumour promoting inflammation

72
Q

What is i) neoadjuvant and ii) adjuvant chemotherapy?

A

NEOADJUVANT: prior to potentially curative treatment
ADJUVANT: following potentially curative treatment, to prevent relapse

73
Q

What is ionising radiation?

A

Radiation energetic enough to displace an electron from its orbit around a nucleus- this electron goes on to interact with other atoms to create free radicals
Used to damage cancer cells whose repair mechanisms are inadequate, causing cell death

74
Q

What is particle radiation?

A

Alpha and Beta

75
Q

What is i) direct and ii) indirect radiation?

A

DIRECT: x-rays directly breaking DNA bonds
INDIRECT: creation of free radicals which break the bonds

76
Q

What is stereotactic radiotherapy?

A

Highly focused radiotherapy delivering radical doses to small areas with surrounding normal structures

77
Q

Give an example of stereotactic radiotherapy

A

Gamma knife

78
Q

What is proton therapy?

A

Better directs the radiotherapy eg to a certain depth

79
Q

Give 2 examples of alkylating agents used for chemotherapy

A

Cisplatin, Cyclophosphamide

80
Q

Give 2 examples of antimetabolites used for chemotherapy

A

Fluorouracil, Methotrexate, Hydroxyurea

81
Q

Define pharmacokinetics

A

What the body does to the drug

82
Q

Define pharmacodynamics

A

What the drug does to the body

83
Q

What 3 features need to be present for a chemotherapy drug to be effective?

A
  1. Drug must reach cancer cells
  2. Cell must be sensitive to the cytotoxic drug
  3. Toxic effect must be minimal to the effect of the drug
84
Q

Side effect of Cisplatin

A

Nephrotoxicity

85
Q

Side effect of Doxorubicin

A

Cardiomyopathy

86
Q

General side effects of chemotherapy

A

Heart failure, nausea, taste changes, infertility, hepatic impairment, renal impairment, immune suppression, peripheral neuropathy, alopecia, constipation, rashes

87
Q

Give an example of immunotherapy used to treat cancer

A

Ipilimumab for metastatic melanoma

–> activates T cells that recognise and kill cancer

88
Q

What is Cancer of Unknown Primary Origin (CUPO)?

A

Metastatic malignant disease without an identifiable primary site

89
Q

Investigations of Cancer of Unknown Primary Origin (CUPO)

A 
History and examination- breast, nodes, skin, genital, rectal, pelvic
Bloods- FBC, U&amp;E, LFT, calcium, LDH
Urinalysis
Myeloma screen
CTTAP
Tumour markers- Ca125, PSA, AFP, BhCG
Testicular USS
Biopsy + histology/immunohistochemistry
90
Q

Presentation of Cancer of Unknown Primary Origin (CUPO)

A

Malaise, fatigue, weakness, weight loss

91
Q

At what point does the spinal cord become the cauda equina?

A

T1

92
Q

What are the commonest primary sites of bone mets?

A

Breast, lung, prostate, myeloma, kidney, thyroid

93
Q

Causes of cauda equina/spinal cord compression

A

Primary malignancy, bony mets, trauma, disc prolapse, RA, spinal infection, epidural/subdural haematoma

94
Q

How do signs of cauda equina syndrome and those of spinal cord compression differ?

A

Spinal cord compression - UMN signs

Cauda equina syndrome - LMN signs

95
Q

Presentation of Spinal cord compression/Cauda equina syndrome

A 
Spinal cord compression - UMN signs
Cauda equina syndrome - LMN signs
Back pain/radicular pain
Limb weakness + sensory loss below level
Bladder/Bowel retention (UMN) or incontinence (LMN)
96
Q

Symptoms of spinal mets without compression

A

Spinal pain aggravated by straining, localised spinal tenderness, nocturnal spinal pain

97
Q

Investigation of Spinal cord compression/

Cauda equina syndrome

A

MRI whole spine

98
Q

Management of Spinal cord compression/

Cauda equina syndrome

A 
Dexamethasone 8mg BD
Analgesia
Bed rest
Surgical decompression
Radiotherapy/Chemo
99
Q

Describe UMN signs

A

Hypertonia
Weakness
Brisk reflexes
No wasting or fasciculations

100
Q

Describe LMN signs

A 
Hypotonia
Weakness
Absent reflexes
Wasting
Fasciculations
101
Q

Define neutropenic sepsis

A

Temperature > 38 or any symptoms or signs of sepsis, in a person with neutrophila < 0.5 x10^9/L

102
Q

Define Sepsis

A

Life-threatening organ dysfunction due to a dysregulated host response to infection

103
Q

Causes of neutropenic sepsis

A

Cytotoxic chemotherapy, haematopoeitic stem cell transplant, immunosuppressive drugs, infections, autoimmune disease, bone marrow failure (aplastic anaemia, myelodysplastic syndromes, acute leukaemia), B12/Folate deficiency

104
Q

Investigations in neutropenic sepsis

A

FBC, U&E, LFT, CRP/ESR, coagulation screen
Blood cultures
Septic screen

105
Q

Management of neutropenic sepsis

A

If on high risk chemo- prophylactic GCSF
IV antibiotics- Tazocin + Gentamicin
Fluids + O2

106
Q

Causes of Superior vena cava obstruction

A
  • Inside vessel- thrombus, intravascular device
  • Inside wall- direct tumour invasion
  • Outside vessel- tumour (lung, lymphoma, germ cell, ALL), fibrosing mediastinitis
107
Q

Presentation of superior vena cava obstruction

A

Facial swelling + redness, periorbital oedema, engorged conjuctivae, arm swelling, breathlessness, cough, distended veins on chest, visual disturbance, headache, syncope, cyanosis

108
Q

Diagnosis of superior vena cava obstruction

A

Clinical diagnosis

109
Q

Investigations in Superior vena cava obstruction

A

CXR- widened mediastinum, mass on right side of heart

CT, Doppler, invasive contrast venography

110
Q

CXR findings in Superior vena cava obstruction

A

Widened mediastinum, mass on right side of heart

111
Q

Management of Superior vena cava obstruction

A

Dexamethasone 16mg OD
Elevate head, O2
Endovascular stenting
Radio/chemotherapy

112
Q

Screening programme for prostate cancer

A

None currently

113
Q

2-week wait criteria for prostate cancer

A

DRE hard nodular prostate

PSA above normal age range eg Age 50-69 >3

114
Q

What lymph nodes drain into the bladder?

A

Obturator, external iliac, internial iliac, common iliac

115
Q

What is the blood supply to the bladder?

A

Vesical arteries- branch from internal iliac arteries

Superior vesical artery branches from umbiliac artery from internal iliac

116
Q

Risk factors for bladder cancer

A

Male, age, smoking, aromatic amines in dyes, pelvic irradiation, cyclophosphamide, Schistosomiasis
SCC- stones/indwelling catheter

117
Q

Types of bladder cancer

A

90% transitional cell carcinoma in developed countries

Rest squamous cell carcinoma

118
Q

How does bladder cancer present?

A

Painless gross or microscopic haematuria

Voiding symptoms in advanced disease

119
Q

Investigations in bladder cancer

A

Urinalysis + culture to exclude infection
CT/MRI
Cystoscopy

120
Q

2 week wait criteria for bladder cancer

A

Age > 45- unexplained visible haematuria without UTI or after UTI has been treated
Age > 60- unexplained non-visible haematuria and either dysuria or raised WCC

121
Q

Management of bladder cancer

A

TURBT +/- lymph nodes
Intravesical Mitomycin C
Cisplatin combo chemotherapy
External beam radiotherapy

122
Q

Types of lung cancer

A

95% bronchial carcinomas

  • 15% Small cell- rapidly growing, highly malignant, poor prognosis, respond to chemo
  • 85% Non-small-cell- squamous, adenocarcinoma, large cell, bronchoalverolar cell
  • Secondaries- kidney, prostate, breast, bone, GI tract, cervix, ovary
123
Q

Risk factors for lung cancer

A

Smoking, COPD, Age, previous Hx cancer, industrial dust diseases, asbestos exposure, EGFR mutation

124
Q

Presentation of lung cancer

A

Cough, dyspnoea, weight loss, chest pain, haemoptysis, clubbing, wheeze, pneumonia
Hoarseness- recurrent laryngeal nerve involvement

125
Q

CXR findings in lung cancer

A

Peripheral circular opacity, hilar enlargement, consolidation, pleural effusion, bony mets

126
Q

Investigations in lung cancer

A

CXR
CT/PET
Bronchoscopy for histology

127
Q

How is lung cancer staged?

A

NSCLC- TNM

SCLC- limited stage disease or extensive stage disease

128
Q

Management of lung cancer

A

Smoking cessation
Surgical resection
Chemo/radiotherapy

129
Q

Complications of lung cancer

A

Recurrent laryngeal/phrenic nerve palsy
Pancoast’s syndrome
Mets
SIADH, Cushing’s

130
Q

Types of testicular cancer

A

95% germ cell tumours- seminoma or non-seminomatous (teratoma)
Other 5% Leydig or Sertoli cell

131
Q

Risk factors for testicular cancer

A

Cryptorchidism/testicular maldescent, Klinefelter’s syndrome, FH, male infertility, low birth weight, infantile hernia, testicular microlithiasis

132
Q

Presentation of testicular cancer

A

Usually painless lump in body of testes, testicular/abdominal pain, dragging sensation, hydrocele
Gynaecomastia from BhCG production

133
Q

Where do testicular cancers metastasise to?

A

Seminomas to para-aortic nodes

Teratomas to liver, lung, bone and brain

134
Q

Investigations of testicular cancer

A

USS confirms diagnosis
Tissue histology after inguinal orchidectomy
Tumour markers- AFP, BhCG

135
Q

Tumour markers for testicular cancer

A

AFP

BhCG

136
Q

What staging system is used for testicular cancer?

A

Royal Marsden Staging I-IV

137
Q

Management of testicular cancer

A

Surgery- Inguinal orchidectomy
Chemo/Radiotherapy
Sperm storage

Finals Revision (13 decks)

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