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RACP Onc > Oncology > Flashcards

Oncology Flashcards

1
Q

Doxorubicin

A

Anthracycline

Intercalation
Free radical damage
Interferes with topoisomerase II after it cleaves ligates DNA

I: ALL, AML, Osteosarcoma, Ewing Sarcoma, Hodgkin Lymhoma, NHL, Neuroblastolma

Cardiac damage
Arrythmia
Radiation dermatitis
Red Urine
Myelosupression
Conjunctivitis
Nausea
Vomiting
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2
Q

Vincristine

A

vinca alkaloid

ALL, NHL, Hodgkin lymphoma, Wilms, Ewing Sarcoma, Neuroblastoma, Rhabdomyosarcoma

Peripheral neuropathy
Jaw pain
(Cellulilits, Constipation, Illeus, SiADH, Seizures, Ptosis, Minimal myelosuppression)

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3
Q

Cyclophosphamide

A

Alkylation agent

myeloid suppression

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4
Q

Etoposide

A

Topoisomerase inhibitor (Topoisomerase mediated strand breaks to DNA)

I: ALL, NHL, Germ Cell tumour, Ewing Sarcoma

ADR: Myelosuppresion, Secondary leukaemia, Nausea, Vomiting

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5
Q

Ifosfamide

A

Fosfamide = Phosphamide
Alkylating agent
Alkylates Guanine - to inhibit DNA synthesis

NHL
Wilms
Soft tissue sarcoma

ADR:
Pulmonary fibrosis
Haemorrhagic Cystists
Myelosuppresion
SiADH
CNS dysfunction
Cardiac toxic
Anaphylasis
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6
Q

Actinomycin-d

A

Xxx

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7
Q

Most common bone cancers?

A

Osteosarcoma
Long bones
Anywhere on bone incl metaphysis

Ewing’s Sarcoma
Diaphysis (middle) of long bone
Pelvis
Vertebral

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8
Q

Busulfan

A

Lung damage

Used in high risk or relapsed Ewing’s Sarcoma

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9
Q

Most common soft tissue sarcoma

A

Rhabdomyosarcoma
Risk increased with LIfreu
Mostly kids under 6

Embroyonal (tests/vagina)
Vs non embroyonal (Alveolar)

Particular mutation in FOXO1 partner PAX3 or PAX7
Detect with breakaway FISH or RTPCR

Head and neck 40%
Genitourinary 20%

Presents with mass and local effects:
Proptosis
PV discharge
CN Palsy
Urinary retention

Imaging locally
Regional LN
LUNGS
Bone marrrow (but super rare)

BIOPSY OF PRIMARY TUMOUR AND SENTINEL LN

Favourable <5cm and age 1-10

unfavourable if parameningeal, extremities, bladder

Most treatment is RADIATION 54Gy
Surgery if resectable

Chemo is essential

VAC Vincristine Actinimycin Cyclophospanide
IFOSFAMIDE in place of Cyclophosphamide
DOXORUBICIN IF METASTATIC

Oral subgroups of ViNorelbine/cyclophosphamide

temSirolimus (mTor inhibitor)

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10
Q

Outcomes for SARCOMAS?

A

localised 65-75%

Metastatic 20-30%

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11
Q

How to treat Leukaemia

A

Induction
Pre treatment with steroid and IT methotrexate

Favourable:
3 drugs
Dexamethasone Asparginase vincristinr

4 drugs (for includes HR or TCell ALL)
Doxorubicin aka anthracycline

Then CNS PROPHYLAXSIS
IT METHOTREXATE (Or other IT CHEMO)
High Dose Methotrexate instead of radiation unless super high risk

maintainance with
6MP

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12
Q

Cancer emergency’s

A

Leuhostasis - lung and brain
Big cells. Lots of them. AML
Haemorrhage
give platelets and urgent cytoreduction (steroids ALL, hydroxyurea AML)

Tumour lysis syndrome
ELEVATED LDH

Rx allopurional and alkaloid hyperhyrdation
If high risk rasburicase (Lyse uric acid) and hyperhydration

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13
Q

Leukaemia prognosis

A

ALL. - 90% cure
AGE 1-5
Good early response (MRD)

AML - 60% survival

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14
Q

Imatinib?

A

Gleevac
TKI antidote to philadelphia protein - a fusion protein

Revolutionised rx of

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15
Q

Common CN lesion for brain tumour

A

CN 6 - Double vision and unable to adduct- owing to long course of CN6

Rapidly progress to CN7 given location - Facial droop/smile asymmetry

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16
Q

Most common site of brain tumours

A

<1 - Supratentorial
>1 Infratentorial

Infratentorial - 1-11 >60% - medullablastoma/ependymosa/brainstem in posterior fossa

Older >11 - any location

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17
Q

What sort of brain tumours spread locally/metastatically

A

Gliomas/Gliomatous only local spread – May be able to spare CNS prophylaxsis radiation and only give local radio if low grade

Embryonal (aka medulloblastoma or PNET) - craniospinal radiation in addition to focal to cover metastatic spread

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18
Q

How frequent is cancer?

A

Annual incidence ~ 1:5000

Cumulative risk to age 20 ~1:300

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19
Q

Aspariginase

A

Depletion of L-Aspariginase

Indications: ALL, AML

ADR: Allergic Reaction PANCREATITIS
Hyperglycaemia
Platelet dysfunction/coagul\opathy
Encephalopathy

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20
Q

Leukaemia - Favourable and unfavourable cytogenetics?

A

More chromosome GOOD
Less chromosome BAD

8: 21 translocation ETV6:RUNX1 - GOOD
9: 22 BCR:ABL - BAD

iCAP 21 - BAD

21
Q

If relapse in Oncology - is early or late better?

A

Late relapse more favourable than early

22
Q

What are Auer rods?

A

Inclusion in cells specific to AML

TINY thin rod in the cytoplasmic portion - rest of the cell is a big nuleus

23
Q

What are Reed Sternberg cells?

A

Bilobular “Owl Eyes’ = Specific for Hodgkin Lymphoma

24
Q

Clinical presentation of AML?

A 
Malaise
LOW
Fever
Myalgia
Arthralgia
Gum hypertrophy
Tumour masses - cutaneous/mucosal etc.
Hepatosplenomegaly
Low Hb/ Low Plt/ High or low lympho
25
Q

Hodgkin Staging?

A

DO A PET

Ann Arbor
I - Single lymph
II - >2 Lymph on same side diaphragm
III - >2 lymph on both sides diaphram
IV - Extralymphatic spread = Dissemination

Combine with B symptoms = Paraneoplastic night sweats, LOW 10% in 6/12 or Fever to stratify

> 85% survival

26
Q

Non Hodgkin Lymphoma Staging

A

Fast GROWING

St Judes
I - 1 lymph group (Not abdo/mediastinum)
II - 1 lymph + local nodes or 2 lymph group same side diaphgram, Or GIT only
III = Thorax/Abdo/Spinal Dura or Cross Diaphragm
IV - SPINE, CNS, Bone Marrow

27
Q

BlinaTumoMab

A

Bispecific T Engager - BITE
CD3 to T
CD19 to B (Tumour)
Causes cytokine release syndrome (fever, hypotension, capillary leak)
Mitigate with steroids or Toculizimab (Anti IL6)

28
Q

CAR-T Cells?

A 
Chimeric Antigen Receptor T Cells
CD 19 targeting CAR-T
Collect autologous
Transfect viral
Amplify
Transfuse
//
May cause persistent B cell depletion
Cytokine release +++
$500,000/per patient
29
Q

BrenTuxiMab

A

Anti CD30
Deliver MMAE - Monomethyl Auristate E
For Hodgkin
Causes cytopaenia

30
Q

Calichamicins?

A

Antitumour antibiotics bounds to Ig
DNA Strand cission through R.O.S.

GemTuzumab CD 33
InoTumomab CD 22

31
Q

Benefits of HSCT?

A

Allows high intensity chemoTx
Allows immune system remoddeling
Allows correciton of bone marrow failure
Allows partial correction of some metabolic defects

//
Mostly treats ALL
32
Q

HLA MHC1 Molecules?

A

HLA - A
HLA - B
HLA - C

Expressed on all cells (Except RBC and Keratocytes)

33
Q

HLA MHC 2 Molecules?

A

HLA DR
HLA DQ
HLA DP

On Antigen Presenting Cells
Dendritic, B cells, lymphocytes, monocytes, marcophages, langerhans cells

34
Q

Compare and contrast different collection protocols for HSCT?

A

Bone Marrow - Get full lineage, DLI, Mod GVHD

Cord - Quick to mature, less GVHD, slow engraftment, low dose (Better for Metabolic indications, “more enzyme”)

Apheresis/PBSC - CD34+ only, collect lots, more GVHD

Notes: Marrow = “Operation”, Apheresis is 2/7 of bone pain and fever hooked to dialysis machine!

35
Q

Regarding transplant matching - What is Haploidentical?

A

From a parent or a Half match sibling

  • Guarantees to share at least one full chromosome - i.e. 50% of genetical material
  • Can be a closer match than we can test for on that portion
A sibling may be a full match (got same chromo as parents)
Half match (One shared chromo)
No match (Got opposite chromo)

BECAUSE - ALL MCH are on Chromosome 6

//
Note - each loss of match in unrelated donors drops survival by 15%
36
Q

What is Sinusoidal Occlusive Disease?

Or Veno-Occlusive Disease

A

Liver Fibrosis due to hepatic venule injury within 30/7 of myeloablative stem cell tx

Clinically:
Weight gain
Hepatomegaly
Ascites

Labs
Thrombocytopaenia
Jaundice

Rx:
Defibrotide

90% of severe disease = death

37
Q

GVHD - Whats the pathogenesis

A

Step 1 - Damage to host cells
Step 2 - Donor derived T- Cells, Antigen Presnting Cells - Minor Histocompatibility antigens (imp. If matched siblings)
- Inflammatory cascade from GIT - > Cytokes IL-2, Interferon,
Step 3 - T-cell mediated toxicitiy, TNF-Alpha from mono/macrophage

//
Skin maculopapular rash
Liver Jaundice
GIT Nausea/Vomiting/Diarrhoea

38
Q

Sever Chronic GVHD?

A

Worse possible transplant outcome

39
Q

Dohle body

A

Light blue stained cytoplasmic inclusion, old ribosomal/ER stuff

40
Q

Kids got blood cancer - ?How to pick out different types?

A

ALL - Most common, age 1-5
AML - Less common, associated gum/cutaneous manifestations, AUER Rods
Hodgkin Lymphoma - 2nd decade of life, prolonged presentation, Lymphadenopathy/Mediastinal mass, B- Symptoms- Reed Sternberg OWL eyes
NHL - Burkitts most common, rapid growing, abdominal mass, Intussception

41
Q

Febrile neutropaenia recovery - ?Left Shift

A

Nah, myelosuppresion.

42
Q

Bone marrow recovery post chemotherapy?

A

About 3 weeks

43
Q

Graft Versus Host disease timing

A

Traditionally <100 days
Correlates with engraftment time- i.e. count recovery
30-50% incidence

  • T CELL MEDIATIED

Prevent with Immunosuppression (Ciclosporin)

Rx with Steroids

Affects Skin, GI, LIver

44
Q

Complications post HSCT?

A

Acute - Graft failure 5-10%, GVHD, Veno-Occlusive Diseaee 15%

INFECTIONS

  • Bacteria (Neutrophils, come back sooner, have ABx)
  • Fungal (Need Neutro and T -cells)
  • Viral - big killers, all T-cell, no antidotes, RSV/Influenza/Adeno virus

Long term - HPA Axis, Hypothyroid, growth failure, pubertal failure/infertility
secondary cancer

Neurocognitive

Worst outcomes if myelo-ablation happens with TBI (Total Body Irradiation) but high dose chemotherapy (e.g. Busluphan = TBI in an pill) still nasty

45
Q

Regarding cell lines - Lymphoid lineage?

A

Pluripotent stem cell
Lymphoid Stem Cell
Pre0B cells and Prothymocytes
Lymphocytes- T cells and B cells and NK cells

46
Q

Regarding cell lines - Myeloid lineage

A

Pluripotent stem cell -> Myeloid Stem cells

Granulocytes - myeloblasts, Neutro/Baso/Eosinophils
Monocyte/Granulocyte Precureor gives rise to Monocytes or Neutrophils
Monoblasts0 < monocyte then macrophage
Proerythrocytblast - reticulocyte - RBC
Megakaryocytes - platelets

47
Q

Who DOESN’t Get Total Body Irradiation with their HSCT for ALL?

A

Kids < 3 definitely, mostly kids <4 - Neurocognitive outcomes more severe

48
Q

Rash that affects palms of hands?

A

Coxsackie

Graft vs Host Disease

Scalded skin Staph/Strep

RACP Onc (1 decks)

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