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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
Hodgkin Staging?
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
Non Hodgkin Lymphoma Staging
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
BlinaTumoMab
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
CAR-T Cells?
``` 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
BrenTuxiMab
Anti CD30 Deliver MMAE - Monomethyl Auristate E For Hodgkin Causes cytopaenia
30
Calichamicins?
Antitumour antibiotics bounds to Ig DNA Strand cission through R.O.S. GemTuzumab CD 33 InoTumomab CD 22
31
Benefits of HSCT?
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
HLA MHC1 Molecules?
HLA - A HLA - B HLA - C Expressed on all cells (Except RBC and Keratocytes)
33
HLA MHC 2 Molecules?
HLA DR HLA DQ HLA DP On Antigen Presenting Cells Dendritic, B cells, lymphocytes, monocytes, marcophages, langerhans cells
34
Compare and contrast different collection protocols for HSCT?
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
Regarding transplant matching - What is Haploidentical?
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
What is Sinusoidal Occlusive Disease? | Or Veno-Occlusive Disease
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
GVHD - Whats the pathogenesis
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
Sever Chronic GVHD?
Worse possible transplant outcome
39
Dohle body
Light blue stained cytoplasmic inclusion, old ribosomal/ER stuff
40
Kids got blood cancer - ?How to pick out different types?
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
Febrile neutropaenia recovery - ?Left Shift
Nah, myelosuppresion.
42
Bone marrow recovery post chemotherapy?
About 3 weeks
43
Graft Versus Host disease timing
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
Complications post HSCT?
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
Regarding cell lines - Lymphoid lineage?
Pluripotent stem cell Lymphoid Stem Cell Pre0B cells and Prothymocytes Lymphocytes- T cells and B cells and NK cells
46
Regarding cell lines - Myeloid lineage
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
Who DOESN’t Get Total Body Irradiation with their HSCT for ALL?
Kids < 3 definitely, mostly kids <4 - Neurocognitive outcomes more severe
48
Rash that affects palms of hands?
Coxsackie Graft vs Host Disease Scalded skin Staph/Strep

RACP Onc (1 decks)

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