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Y4 > Oncology > Flashcards

Oncology Flashcards

1
Q

WHO Performance status has a number range from __ to __ ?

A

0 to 5

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2
Q

What would the WHO performance status be: dead

A

5

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3
Q

What would the WHO performance status be: fully active, no restrictions

A

0

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4
Q

What would the WHO performance status be: completely disabled, totally confined to a bed/chair

A

4

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5
Q

What would the WHO performance status be: unable to do any self care

A

4

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6
Q

What would the WHO performance status be: unable to do strenuous activities but able to carry out light work duties

A

1

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7
Q

What would the WHO performance status be: confined to a bed/chair for more than 50% of waking hours. Ambulant for less than 50% of the day

A

3

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8
Q

What would the WHO performance status be: out of bed more than 50% of waking hours. Ambulant for over 50% of the day.

A

2

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9
Q

What is the usual WHO performance status cut off score for chemotherapy?

A

Usually 2 is the highest

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10
Q

What is the purpose of the WHO performance status?

A

Gives the dr an overall impression of the patient’s fitness so that they can have an idea of the likelihood of running into problems with treatment

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11
Q

What is an oncological emergency

A

A complication related to cancer or anti-cancer therapy that requires immediate intervention otherwise it could be life threatening

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12
Q

Name 6 examples of oncological emergencies

A 
SVC obstruction
Spinal cord compression
Neutropenic sepsis 
Cardiac tamponade 
Hypercalcaemia 
Pulmonary embolism
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13
Q

Define neutropenic sepsis

- including the neutrophil levels

A

Signs of sepsis + neutrophils < 1.0 (if chemotherapy given in past 21 days)

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14
Q

If a patient has neutropenia (neutrophils <1.0) but no signs of infection, what should you do?

A

Nothing, no need for treatment if patient doesn’t possess any signs of infection

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15
Q

If a patient on chemotherapy develops neutropenic sepsis, what should you find out about their chemotherapy?

A

Date of last chemotherapy
Type of chemotherapy
Were blood products administered?

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16
Q

If patient has neutropenia (neutrophils <1.0) a temperature of over 37.5 degrees but no other signs of infection, what should you do?

A

Treat immediately

  • initiate sepsis 6
  • give antibiotics immediately
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17
Q

Once you find out a patient has neutropenic sepsis, what is the first thing you should do?

A

Give antibiotics URGENTLY

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18
Q

Management of neutropenic sepsis?

A

SEPSIS 6

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19
Q

Which antibiotics are used in neutropenic sepsis?

A

IV Tazocin 4.5g QDS + gentamicin

- want a broad cover

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20
Q

Spinal cord compression is most commonly seen in which 4 cancers

A

Breast
Lung
Prostate
Bladder

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21
Q

What is usually the first symptom in a spinal cord compression

A

Pain

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22
Q

Describe the pain experienced in spinal cord compression?

A 
Radicular pain (band like, burning) 
Worse when coughing/straining
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23
Q

Spinal cord compression signs and symptoms

A

Pain (radicular)
Weakness
Sensory alteration - numbness, foot drop
Urinary retention

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24
Q

In spinal cord compression, which symptoms come first: sensory symptoms or motor symptoms?
- why is this

A

Motor symptoms come first
- cancer usually comes from the vertebral body (remember the vertebral body is positioned anterior to the SC) and the cancer works posteriorly so it hits the ventral horn first (motor) before the dorsal horn (sensory)

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25
Q

What is the first line urgent investigation in a patient with spinal cord compression?

A

Urgent MRI scan

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26
Q

Management options in spinal cord compression

A

Dexamethasone
- to reduce vasogenic oedema

Surgery
- if confined and patient able to go under GA

Radiotherapy

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27
Q

Causes of SVC obstruction can be split into 2 categories. what are these?

A

Causes within the SVC

  • clot
  • foreign body
  • cancer

Causes outwith the SVC (and compressing it from the outside)
- cancer

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28
Q

SVC obstruction - which type of lung tumour is most likely to cause extrinsic compression on the SVC? SCLC or NSCLC

A

SCLC

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29
Q

SVC obstruction - clinical presentation

A

Swelling of the face, neck, arms
distended veins
shortness of breath
headache

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30
Q

SVC obstruction - initial investigation

A

CXR

  • look for tracheal deviation
  • look for evidence of tumour
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31
Q

SVC obstruction - management if the cause is a clot

A

thrombolysis

anti-coagulation

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32
Q

SVC obstruction - management if the cause is compression from a mass

A

Dexamethasone
Stent
Chemotherapy
Radiotherapy

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33
Q

Cancer patients are more/less likely to clot

A

More likely

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34
Q

What is the link between hypercalcaemia and cancer?

A

Most calcium is stored in the bone so if there is bone destruction (which can happen in cancer) then this can cause hypercalcaemia

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35
Q

What are the 2 most common causes of hypercalcaemia?

A

Malignancy

Hyperparathyroidism

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36
Q

Hypercalcaemia is when the corrected calcium level is over which value?

A

> 2.55mmol/l

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37
Q

Malignant hypercalcaemia - presentation

A 
Pain 
Thirst
Polyuria 
Confusion
Anorexia 
Constipation
Poor concentration 
Itch
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38
Q

If you suspect malignant hypercalcaemia, which investigations should you carry out?

A 
Calcium
Corrected calcium 
PTH - if raised, suspect primary hyperparathyroidism 
U+E - look for dehydration
Myeloma screen
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39
Q

Malignant hypercalcaemia - what is the most important test to guide management?

A

U+E

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40
Q

What is the first step in the management of malignant hypercalcaemia?

A

REHYDRATION

  • 3-4L 0.9% saline in 24 hours
  • monitor urine output
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41
Q

What is the maangemetn of malignant hypercalcaemia?

A

Rehydration first then

bisphosphinates

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42
Q

What is a bisphosphinate used in the treatment of malignant hypercalcaemia ?

A

Pamidronate IV 60-90mg over 2 hours

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43
Q

What is the function of bisphosphinates

A

They adsorb to bone and block osteoclast-mediated bone resorption

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44
Q

How many days do bisphosphinates take to work?

A

3-5 days

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45
Q

If a patient has bisphosphinates but the next day there is no improvement in the symptoms, should you continue to give bisphosphinates?

A

No ???

wait for a few days to see the effect of the bisphosphinates

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46
Q

Buzzword for tumour lysis syndrome

A

Abnormal electrolytes

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47
Q

Name 2 cancers which are most likely to cause tumour lysis syndrome?

A

Lymphoma

Germ cell tumours (testicular tumours)

48
Q

What are the abnormal electrolytes in tumour lysis syndrome

A

Raised potassium
Raised phosphates
Low calcium

49
Q

Management of tumour lysis syndrome

A

Prevention

Uric acid reduction (allopurinol or rasburicase)

50
Q

Tumour lysis syndrome - how can you correct electrolytes immediately

51
Q

Which cardiac protection should you consider for hyperkalaemia?

A

calcium gluconate

52
Q

Cardiac tamponade - pathophysiology

A

pericardial effusion develops and compresses the ventricle, reducing the cardiac output. This increases venous back pressure

53
Q

Cardiac tamponade results in

A

Diastolic heart failure

muffled heart sounds on auscultation

54
Q

Causes of cardiac tamponade

A

Trauma
Malignancy
Infection
Post MI

55
Q

Clinical presentation of cardiac tamponade

A

Shortness of breath
Fatigue
Palpitations
Symptoms of pericarditis

56
Q

Clinical signs of cardiac tamponade

A

Muffled heart sounds
Pulsus paradoxus
Pericardial rub

57
Q

Management of cardiac tamponade

A

Pericardiocentesis - done by a cardiologist

58
Q

PE - clinical features

A

Acute deterioration in shortness of breath
Pleuritic chest pain
Unilateral leg swelling
Tachycardia

59
Q

SIADH is most commonly associated with which tumour

60
Q

Management of SIADH

A

Fluid restriction

61
Q

Ras is

  • oncogene
  • tumour suppressor gene
62
Q

p53 is

  • oncogene
  • tumour suppressor gene
A

Tumour suppressor gene

63
Q

Which lung cancer is most common

  • SCLC
  • NSCLC
64
Q

What is NSCLC further divided into

A

Adenocarcinoma
Squamouc cell
large cell

65
Q

What is the most common lung cancer seen in non smokers?

A

Adenocarcinoma

66
Q

What is the explanation of hoarse voice symptom of lung cancer?

A

Due to the tumour invading the recurrent laryngeal nerve branch of CN X

67
Q

Which sign might you elicit when looking for SVC obstruction, and what is it?

A

Pemberton’s sign

Get patient to put hands above head and this causes facial congestion and cyanosis

68
Q

SIADH is often associated with which type of lung cancer?

A

SCLC

-Ectopic release of ADH by the small cell lung cancer can result in hyponatraemia.

69
Q

What is the first line treatment of squamouc cell carcinoma of the oesophagus

A

Radical chemotherapy with radiotherapy

70
Q

What is Virchow’s node and which cancer is it associated with

A

Enlargement of left supraclavicular node

Associated with gastric cancer

71
Q

Main risk factor for developing cholangiocarinoma

72
Q

Which syndrome can cause neuroendocrine pancreatic cancer

A

Von Hippel Lindeau syndrome

73
Q

Painless Jaundice
Weight loss
Back pain
Lethargy
Steatorrhea
Diarrhoea
Make you think

A

Pancreatic cancer

74
Q

What is the name of the surgical procedure for pancreatic cancer

A

Whipple’s procedure

75
Q

Where does an insulinoma arise?

A

Beta cells of the pancrease which secrete insulin

76
Q

Clinical features of insulinoma

A 
Episodic hypoglycaemia 
Mood changes 
Lethargy
Hunger 
Sweating
77
Q

Excessive thirst and hunger
Unintentional weight loss
High blood sugar

These symptoms may be present with which tumour

A

Glucagonoma

78
Q

HNPCC (lynch syndrome) is associated with which other cancer?

A

Endometrial cancer (gynae)

79
Q

What is the biggest risk for developing anal cnacer?

80
Q

Neutropenic sepsis is defined as sepsis in a cancer patient with a neutrophil count

A

less than 0.5

81
Q

pericardial tamponade can lead to SYSTOLIC/DIASTOLIC heart failure

82
Q

In terms of pagets disease of the nipple, how is this related to breast cancer

A

It is high grade DCIS involving the nipple skin

83
Q

Which biopsy method is used for ?breast cancer

  • FNA
  • core needle biopsy
  • vaccum biopsy
A

Core needle biopsy

84
Q

If a breast cancer is ER +ve what does this mean

A

Breast cancer contains oestrogen receptors, meaning they depend on oestrogen for growth

85
Q

If a breast cancer is HR +ve what does this mean

A

Breast cancer is hormone receptor positive, it contains BOTH oestrogen and progesterone

86
Q

If a breast cancer is HER-2 +ve, what does this mean

A

These are breast cancers which over express the HER2 protein, meaning that they tend to grow and spread faster than other types of breast cancer but can be treated with drugs that target the HER2 protein.

87
Q

If the breast cancer is ER+ve, what hormone therapy is given

A

Tamoxifen

- this is an oestrogen receptor antagonist

88
Q

If the breast cancer is HER-2 +ve, what hormone therapy is given?

A

Trastuzumab (Herceptin)

89
Q

In relation to CIN (cervical intraepithelial neoplasia), what is koilocytosis?

A

The presence of structurally abnormal squamous cells

90
Q

In relation to CIN (cervical intraepithelial neoplasia), what is dyskaryosis

A

Abnormal nucleus

91
Q

What is the surgical treatment for endometrial cancer

A

Hysterectomy with bilateral salpingo-oophrectomy

92
Q

Young woman with ovarian cancer - what type could it likely be

A

Germ cell tumour

93
Q

For germ cell ovarian tumour, which three tumour markers should you be aware of

A

AFP
b-hCG
lactate dehydrogenase

94
Q

What is the most common malignant primitive germ cell tumour

A

dysgerminoma

95
Q

triad of right pleural effusion, ascites or raised CA125 suggests

A

Meig’s syndrome

96
Q

Lower gynaecological cancers use which staging

97
Q

Which lymph nodes does vulval cancer typically spread to?

A

Inguinal lymph nodes

98
Q

When may oophrectomy be an option in the management of breast cancer?

A

Pre-menopausal women

99
Q

Smoking is linked in the aetiology of which 1 of the following cancers

  • prostate cancer
  • melanoma
  • hepatocellular carcinoma
  • bladder cancer
A

Bladder cancer

100
Q

What is the mechanism of tamoxifen

A

It is an oestrogen receptor antagonist

101
Q

Alcohol induced pain makes you think

A

Hodgkins lymphoma

102
Q

Infection with EBV increases your risk of which cancer (haematological)

A

Hodgkin’s lymphoma

103
Q

Reed sternberg cells suggest

A

Hodgkin’s lymphoma

104
Q

Which is more common: B cell or T cell lymphoma

105
Q

What is the key diagnostic test in lymphoma

A

Lymph node biopsy

- look for reed sternberg cells - this indicated Hodgkin’s

106
Q

MALT lymphoma is associated with

A

H. Pylori infection

107
Q

Which type of antibody is most common with myeloma

108
Q

Management of bone lesions in myeloma

A

Bisphosphonates

109
Q

Which type of nephropathy do you get with myeloma

A

Cast nephropathy

110
Q

What may be found in the urine in a patient with myeloma

A

Bence Jones protein

111
Q

In myeloma, there is raised / reduced plasma viscosity?

A

Raised (blood is thicker)

112
Q 
Elevated calcium 
Renal failure 
Anaemia 
Bone pain 
Makes you think
113
Q

Initial investigations for ?myeloma

A 
FBC (reduced WCC) 
Plasma viscosity (raised) 
Calcium (raised) 
ESR (raised)
114
Q

If bloods come back suggestive of myeloma, which investigations are done

A

Serum protein electrophoresis

Bence jones proteins in urine (urine electrophoresis)

115
Q

Which investigation is used to confirm the diagnosis of myeloma

A

Bone marrow biopsy

116
Q

Raindrop skull on Xray makes you think

Y4 (23 decks)

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