Oncology Flashcards
1
Q
SE unique to oxaliplatin
A
cold sensitive peripheral neuropathy
2
Q
In stage 2 colorectal cancer, in which setting should you give adjuvant chemotherapy.
A
Give adjuvant therapy only if MSI stable. No benefit if MSI high
3
Q
If a patient is T3N1 colorectal cancer, what chemo do they receive and what duration?
A
FOLFOX, CapeOX. 3 months
4
Q
If a patient is T3N2 colorectal cancer, what chemo do they receive and what duration?
A
FOLFOX, CapeOX. 6 months
5
Q
MOA of Cetuximab
A
EGFR inhibitor - works best in RAS wild type cancers
6
Q
Pembrolizumab has most clinical benefit with what feature of CRC
A
MSI high tumors
7
Q
Most common non CRC in Lynch syndrome
A
Endometrial cancer
8
Q
The risk of triple negative breast cancer is greatest with which gene?
A
BRCA 1
9
Q
Antibody related with highest risk for malignancy
A
Anti-TIF1-gamma
10
Q
chemo agent most likely to cause infertility
A
cyclophosphamide
11
Q
Chemo drug causing severe pain and tissue damage on extravasation
A
Doxorubicin
12
Q
SE Bleomycin
A
Pulmonary toxicity
13
Q
SE Doxorubicin
A
Extravasation reaction/ tissue necrosis Cardiotoxicity
14
Q
SE Vinblastine
A
Peripheral neuropathy, neutropenia
15
Q
SE Dacarbazine
A
GI toxicity
16
Q
Enzyme which metabolises Capecitabine/ 5FU
A
Dihydropyrimidine dehydrogenase
17
Q
Most common symptom in advanced cancer
A
pain
18
Q
Most chemo resistant cancer
A
Renal cell
19
Q
Biggest risk factor for ovarian failure with cyclophosphamide
A
Womans age - linear relationship between age and ovarian failure.
20
Q
mantle radiotherapy is at highest risk of which cancer?
A
Breast cancer
21
Q
Late onset toxicity of ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)
A
Hypothyroid MDS Infertility Cardiomyopathy
22
Q
Pertuzumab MOA
A
Prevents HER2-HER3 dimerisation
23
Q
AFP is high in which cancers
A
non-seminomatous cancers
24
Q
bHCG is high in which cancers
A
seminomatous cancers (and a few non-seminomatous) Note all testicular cancers have high LDH.
25
Chemo causing SEVERE diarrhoea
5FU/Capecitabine
Irinotecan
Ipilimumab
26
Chemo causing cardiotoxicity
Doxorubicin (most) Trastuzumab TKI's 5FU
27
Chemo causing acneform rash
EGFR inhibitors - erlotinib, gefitinib, cetuximab
28
Chemo causing Plantar-palmar hyperkeratosis
BRAF inhibitors (RAF makes them rough)
29
Chemo causing Palmar-plantar erythrodysaesthesia/ hand-foot syndrome
5FU/ Capecitabine TKI's - sunitinib, sorafenib
30
Chemo agents which stop the cell cycle (list for each phase)
G0 - Nil
G1 - Tamoxifen, Doxorubicin. (Topoisomerase/DNA breaks)
S - Methotrexate, Gemcitabine, 5FU. (thymidalate/DNA synthesis)
G2 - Etoposide, Bleomycin (Topoisomerase/DNA breaks)
M - Taxanes, Vinca-alkaloids (microtubules)
31
Expression of what protein is required for Tamoxifen to suppress ERBB2/HER2
PAX2. (if PAX2 is low and AIB1 is high then it causes increased ERRB2 expression)
32
Highest risk factor in invasive breast cancer
Axillary node involvement
33
Management of chemo induced diarrhoea
1. oral fluids 2. Loperamide 3. oral ABx 4. discontinue chemo/radio 5. stool specimen 6. IVT 7. IV ABx 8. Octreotide
34
2 types of Prostate cancer
Castrate sensitive Castrate resistant
35
Management options for Castrate sensitive prostate cancer
Bilateral orchidectomy GNRH agonists - Goserelin, Leuprolide GNRH antagonists - Degarelix Chemotherapy
36
What is the issue with using GNRH agonists?
Clinical flare phenomenon - cancer intially grows with hormone flare. Increased risk of cardiovascular disease.
37
Mutation causing EGFR agent resistance
T790M
38
drug for T790 mutation in NSCLC
Osimertinib
39
EGFR mutation location
exon 19 deletion.
40
BRAF pathway resistance is caused by
MEK mutation
41
drug used to prevent BRAF V600 pathway resistance
MEK inhibitor - Trametinib
42
Lapatinib MOA
TKI against HER2
43
Ribociclib MOA
CDK4/6 inhibitor - causes reactivation of Rb which causes G1 cell cycle arrest.
44
Drug used to increase 5FU half life in CRC treatment
Leucovorin
45
Definition of stage 4 lung ca
metastatic disease OR malignant effusion OR lesion in contralateral lung.
46
MOA of p53
causes cell cycle arrest in G1 if there is any DNA damage or mutation.
47
Radiotherapy technique to prevent radiation when moving/breathing
Gating - only emits beam when location is within field - therefore will stop/adjust if tumor moves outside field during breathing.
48
Genetic condition causing renal cell carcinoma
Von Hipple Lindau - regulates hypoxia inducible factor 1α (HIF1α).
49
Von Hipple Lindau disease symptoms and signs
Symptoms - neurological + visual + ataxia. angiomatosis, hemangioblastomas, pheochromocytoma, renal cell carcinoma, pancreatic cysts, epidydimal cysts.
50
In which cancers is nucleotide excision repair most important?
Lung and skin cancer. Nucleotide excision repair removes DNA damaged by carcinogens (smoking and sun damage)
51
Most common SE of Bevacizumab
Hypertension
52
Treatment of Carcinoid syndrome
Octreotide
53
Drug combination used for chemotherapy induced nausea and vomiting prevention
Dexamethasone + Ariprepitant + 5HT3
54
Most emetogenic chemo agent
Platinum's
55
Best drug for preventing metastatic fractures
Denosumab (better than Zolidronic acid)
56
Management of SVC syndrome
1. FNA for histological diagnosis 2. Radiation
57
Cause of fatigue in CTLA4 use
adrenalitis
58
Mx of stage 3 CRC and duration.
Surgical resection + Adjuvant FOLFOX - can have 3 months of chemo unless T4 or N2 (then need 6 months)
59
When to use Cetuximab/ Panitumumab in CRC
KRAS wild type
60
CRC screening guidelines
Image
61
MOA of Pertuzumab
Strops HER2-HER3 dimerization
62
MOA of Fulvestrant
Oestrogen receptor down-regulation
63
GnRH ANtagonist
Degaralix
64
Management of Limited stage SCLC
Chemoradiotherapy + whole brain radiotherapy
65
Management of extensive stage SCLC
Chemotherapy + Atezolizumab (PDL1)
66
Difference between Cisplatin and Carboplatin
Cisplatin - more tocix, increased neurotox, ototox, renal toxicity.
Carboplatin - less toxic, more myelosuppression.
67
Difference between treatment in MSI low and MSI high stage 2 CRC
NO adjuvent chemotherapy if MSI high
68
MSI high stage 4 CRC treatment
Good response to immunotherapy.
69
Best immunotherapy for L sided CRC vs R sided CRC
L sided - EGFR inhibitors (but must be RAS wild type)
R sided - VEGF inhibitor
70
Management of Stage 4 NSCLC with PDL1 expression \<50%
Chemotherapy + Pembrolizumab
71
Management of Stage 4 NSCLC with PDL1 expression \>50%
Pembrolizumab monotherapy
72
Cause of myoclonus in a palliative care patient
Neurotoxicity with opioids - associated with metal clouding. Reduce opioids where possible and start benzo's
73
PSA testing option for Men over 50.
Offer PSA testing every 2 years until the age of 69, and offer further investigations if the PSA is \> 3.0 ng/m
74
Indications for BRCA testing
- triple negative breast cancer
- ovarian cancer
- male breast cancer
- breast cancer + 1 relative with breast cancer
- breast ca + more than one relative w breast ca
- breast ca + more than one relatives with prostate cancer or pancreatic cancer
- breast cancer and Ashkenazi Jew
- NO breast ca + 2x first degree relatives w breast ca \<50
- A relative with a known BRCA1 or BRCA2 mutation
75
Management of menopause symptoms post breast cancer therapy.
Cannot use hormonal therapy as usually used in menopause due to breast ca risk.
nonhormonal pharmacotherapy such as gabapentin SSRIs/SNRI. If on tamoxifen, SSRIs can interfere with CYP2D6 metabolism - Venlafaxine interacts the least.
76
MOA of PARP
single strand base excision repair
77
How much radiation is in a mammogram
3 months worth of normal sun exposure
78
Type of breast cancer commonly missed on mammography
lobular
79
When to discontinue anthracyclines (Doxorubicin)
- symptomatic heart failure
- EF \<50%
- absolute decrease in EF \>10%
80
Mechanism of cardiotoxicity with Capecitabine/ 5FU
Coronary artery vasospasm. Do not rechallenge
81
Cardiac SE of most 'nibs
long QT and hypertension
82
what are the HER tyrosine kinase inhibitors
neratinib and lapatinib
83
Management of HER2 agent (Trastuzumab) cardiotoxicity
Withhold agent for 4 weeks if:
- symptomatic
- EF drop by \>16%
- EF \<45%
84
Best agent for RADIATION induced nausea
Ondansetron
Dexamethasone if brain radiation
85
Management of radiation cystitis
use of a urine alkaliser
use of NSAID
use of alpha-1 blocker
86
Drug causing verrucal keratosis (wart looking) and Plantar-palmar hyperkeratosis
BRAF and MEK inhibitors
87
For patients on CTLA4 and PD1 agents, which should be ceased first in immune related diarrhoea
cease CTLA4 (grade 2) , could continue PD1 once symptoms improve.
DO NOT give steroids if bowel perforation is present
88
Management of immunotherapy cardiac toxicity
cease agents. DO NOT recommence.
High dose steroids
Cardiology referral
89
Immunotherapy related side effects and manegement
1. Cardiotoxicity - cease treatment
2. Endocrinopathies. Continue treatment and give steroids unless adrenal crisis. Give hormone replacement. Treat T1DM with insulin.
3. GI tox/diarrhoea - continue treatment in grade 1. Withhold until improved in grade 2. Cease CTLA in grade 3, cease both in grade 4.
4. Haematological - all of the immune cytopenias
5. Hepatitis
6. Inflammatory arthritis - paracetamol, NSAISD, pred.
7. Neuro - aseptic meningitis, myasthenia gravis, GBS, neuropathy.
8. Pulmonary toxicity
9. Renal - tubulointerstitial nephritis
10. Rash/ SJS
90
Management of immunotherapy related kidney disease
Grade 1 - Creatinine \>1 to 1.5 x ULN
or \>1.0 to 1.5 x baseline, monitor only. Dont cease agents
Grade 2 - Creatinine \>1.5 to 3.0 x ULN
or \>1.5 to 3.0 x baseline. Withold treatment and give steroids. Recommence treatment if it improves.
Grade 3/4 - Creatinine \>3.0 x ULN
or \>3.0 x baseline. Cease treatment and give steroids
91
Chemo agent causing capillary leak and pulmonary oedema due to systemic release of cytokines
gemcitabine
92
Management of radiation pneumonitis
Corticosteroids\* - Pneumocystis jiroveci infection (PJP) prophylaxis is recommended
Consider bronchodilators (limited evidence). Consider humidifier (limited evidence). Supplemental oxygen if required.
93
Mutation found in Gastro intestinal stromal tumors (GIST) (2)
PDGFRA and KIT
94
Benefit of GNRH antagonists (degaralix) over GNRH (goserelin/ leuprorelin) agonists in prostate cancer.
- reduced cardiovascular mortality
- faster onset of efficacy without initial surge seen on agonists
95
For what mutation is entrectinib used for?
NTRK fusion - seen in \<1% of cancers.
96
How to determine if chemo is needed for HR+, HER2- breast cancer
Oncotyping recurrance score is done which includes 21 genes.
High score \>26 needs chemo.
Low score \<25 does not need chemo unless age \<50
97
vinyl chloride exposure is a RF for which cancer
Glioma
98
Genetic syndromes with increased risk of CNS cancer
- NF1
- Von hipple Lindau
- Tuberous sclerosis
99
Treatment for CNS cancers
1. Temozolomide - purine methylator
2. PARP inhibitors.
3. Chemo - localised carmustine wafer.
100
Breast cancer therapy also good for osteoporosis
Raloxifene
101
Hormone therapy for breast cancer in young women vs post-menopausal women
Young - SERMs - Tamoxifen.
Old/ post menopause - Aromatase inhibitors (Anastrozole/Letrozole), the SERM Raloxifene is also beneficial for osteoporosis.
102
Role of Leucovorin in chemotherapy regimes
increases half life of 5FU
103
Colorectal ca follow up screening
CEA 3 monthly
CT CAP yearly for 3 years
colonoscopy at 3 and 5 years
104
Follow up maker for anorectal cancer
ctDNA
105
Chemo for Gastric cancer
HER2 agents if HER2 positive
FLOT chemo - flurouracil, leucavorin, oxaliplatin, taxanes
106
Chemo for testicular cancer
BEP - bleomycin, etoposide, platinums
107
Biggest RF for ovarian cancer
advanced age
108
Which agent adds survival benefit to ovarian cancer when used with chemotherapy
VEGF inhibitors
109
Which type of chemotherapy have better efficacy/SE for ovarian cancer - IV or peritoneal.
Peritoneal
