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RACP Written Exam 2021 > Oncology > Flashcards

Oncology Flashcards

1
Q

What is the role of P53 in the prevention of cancer

A

P53 = tumor supressor gene
Activation of P53 leads to arrest in the G1 phase of the cell cycle allowing for cells to repair DNA before proceeding to S phase (where DNA is replicated).

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2
Q

Which familial cancer syndrome is associated with a germ line mutation of P53

A

Li-Fraumeni Syndrome (SBLA)

  • Sarcoma
  • Breast
  • Leukemia
  • Adrenal Gland
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3
Q

What is the most common cause of renal clear cell carcinoma?

A

Von Hippel Lindau Gene mutation.
In the absence of VHL hypoxia inducible factor accumulates leading to production of several growth factors and enhance glycolosysis

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4
Q

Von Hippel Lindau Syndrome

A

Inherited, autosomal dominant syndrome manifested by a variety of benign and malignant tumors.
●Hemangioblastomas of the brain (cerebellum) and spine
●Retinal capillary hemangioblastomas (retinal angiomas)
●Clear cell renal cell carcinomas (RCCs)
●Pheochromocytomas
●Endolymphatic sac tumors of the middle ear
●Serous cystadenomas and neuroendocrine tumors of the pancreas
●Papillary cystadenomas of the epididymis and broad ligament

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5
Q

What is the function of mismatch repair?

Example of familial cancer syndrome caused by failure of MMR

A

Mismatch Repair corrects replication errors that cause incorporation of the wrong nucleotide (mismatch) and nucleotide deletions/insertions.
Lynch Syndrome

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6
Q

What is the function of Nucleotide excision repair?

A

Removes helix distorting adducts on DNA e.g those caused by UV light or tobacco smoke and contributes to the repair of intrastrand and inter strand crosslinks.

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7
Q

What is the mechanism of PARP inhibition

A

Impair DNA repair pathway leading to accumulation of defects that in healthy cells are repaired by alternative Homogolous repair pathways but in HR mutated cells (i.e. BRCA1/2) the accumulated damage is not repaired and therefore are apoptosed - tutor selective cell death “synthetic lethality”

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8
Q

When is Parp inhibitor ‘Oliparib’ indicated in ovarian cancer

A

monotherapy for maintenance treatment of patients with platinum-sensitive relapsed BRCA-mutated high grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer who arein partial or complete response followingat leasttwo courses of platinum-containing regimens.

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9
Q

Risk factors for Type 1 Endometrial Cancers

A

Unopposed oestrogen states

  • Obesity
  • Nulliparity
  • Early menarche/late menopause
  • Chronic anovulatory state
  • Tamoxifen

Protective = OCP

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10
Q

Risk factors for Cervical Cancer

A

HPV 16/18
Smoking
Immunosupression

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11
Q

Bevacizumab (anti VEGF) in gynaecological cancers

A

Metastatic cervical cancer

Stage 4 Breast cancer

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12
Q

TKI used in metastatic NSCLC with EGFR mutation first line

A

Erlotinib
A/E = acneaform rash.
- Treat with topical or oral tetracyclines, topical steroids, skin care and sun protection

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13
Q

TKI used in metastatic NSCLC with EGFR mutation when resistance to erlotinib occurs and which mutation must they have?

A

Osimertinib (must have mutation of T790)

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14
Q

TKI used in metastatic NSCLC with ALK mutation first line

A

Alectanib is now listed as first line on the PBS

Brigatinib (particularly in patients with intracranial metastases)

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15
Q

TKI used in metastatic NSCLC with Ros-1 mutation first line

A

Crizitonib

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16
Q

In which patients with metastatic NSCLC is pembrolizumab/nivolumab indicated first line?

A

PDL-1 >50% (keynote trial)

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17
Q

Regardless of PDL-1 status which immune checkpoint inhibitors can non-small cell lung cancer patients be commenced on as second line therapy?

A

Nivolumab or Atezolizumab

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18
Q

Classification of small cell lung cancer

A 
Limited (within one radiation field) 
or Extensive (extends over one radiation field)
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19
Q

Small Cell Lung Cancer Limited disease treatment

A

Chemoradiotherapy
Chemotherapy 2 cycles: Platinum based + etoposide
Radiotherapy
Prophylactic brain radiotherapy

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20
Q

Common metastatic site of small cell lung cancer

A

Brain. Therefore brain MRI important in the work up (CT if MRI not available)

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21
Q

What predicts for lack of response to Cetuximab in bowel cancer

A 
KRAS mutated
(Only benefit shown in KRAS wild type)
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22
Q

Use of CEA in cancer monitoring?

A

Used to monitor for early recurrence

Note can also be elevated in smoking and other malignancies ie lung cancer

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23
Q

Ca125 elevation

A

Ovarian Cancer

Non malignant fluid third spacing - i.e ascites

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24
Q

How to treat hypercalcaemia of malignancy

A
  1. IVF
  2. Zoledronic acid
  3. Furosemide if/when euvolaemic.
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25
Q

Malignant spinal cord compression

A 
Back pain + Neuro symptoms 
Upgoing planters (differentiates from cauda equine syndrome) 
MRI 
Rx
> Surgery 
> Radiotherapy
> Steroids 
> Chemo if sensitive (lymphoma/germ cell tutor/SCLC)
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26
Q

BRCA mutation associated with prostate cancer

A

BRCA2

Note both BRCA mutations (autosomal dominant) are associated with increased risk of pancreatic cancer.

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27
Q

Initial investigation on identification of either palpable breast mass/positive breast screening

A

Triple testing

  • Clinical exam
  • Imaging with MMG or US (US if younger)
  • Biopsy: Core or FNA
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28
Q

Trastuzumab adverse effects

A

Reversible cardiomyopathy

> Monitor with regular echo

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29
Q

Mutations in NSCLC

A

EgFR: Elotonib

ALK/ROS: Crizotinib 
                  Alecitinib 
PDL1>50%: Pembroluzimab 
PDL 1-49%: PDL-1 inhibitor + Chemotherapy 
PDL<1%: Chemoimmunotherapy
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30
Q

Two most important factors for melanoma prognosis

A

Breslow depth

Mitotic rate

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31
Q

Most common mutation in Melanoma

A

BRAF 35-45%

> 80-90% V600E

32
Q

BRAF inhibitors

A

BRAF
Vemarufanib + Dabrafenib
BRAF+MEK Inhibitors

Note current first line treatment is BRAF+MEK inhibitor

Adverse effects
> Pyrexia
> Photosensitivity
> Rash and pruritus

33
Q

Mutation negative

A

Ipilimumab + Nivolumab
If CNS disease or LDH high
Either if no CNS disease or LDH normal

34
Q

Where do monoclonal antiodies exert their effect

A

Extracellular

35
Q

Where do TKI’s exert their effect?

A

Intracellular

36
Q

Side effect of Sunitinib

A

Hypertension (anti-angiogenesis)

37
Q

What is the treatment for acquired EGFR T790M mutation in NSCLC

A

Osimertinib.

A/E: QTC prolongation

38
Q

Mechanism of action of Trastuzumab Emtansine (T-DM1)

A

Antibody-drug conjugate
Trastuzumab linked with emtansine. Targeted lethality.
A/E: Thrombocytopenia

39
Q

Mechanism of action of CKK4/6 inhibitors (i.e. Palbociclib)

A

CDK4/6 functions to inhibit retinoblastoma which allows the progression of the cell cycle. Inhibiting the CDK4/6 lead to reactivation of retinoblastoma –> arrest of cell cycle in G1.

Adverse Effects: Neutropenia, LFT Abnormalities

40
Q

Treatment for metastatic renal cell carcinoma

A

Good prognosis: TKI (sunitinib/pazopanib) Note previously routine cytoreductive nephrectomy but questioned by the Carmena trial
Poor prognosis: Ipilimumab & Nivolumab

Second line therapy includesL

  • Nivolumab or sonitinib/pazopanib
  • Carbozatinib
  • Axitnib
  • Everolimus
  • Sorafenib
41
Q

Sunitinib side effects

A 
Hypertension (predicts response) 
Hand and foot syndrome
Neutropenia and thrombocytopenia 
LV dysfunction
Hypothyroidism 
Skin and hair discolouration
42
Q

Mechanism of action of sunitinib/pazopanib/axitinib/sorafenib

A

TKIs that targets the VEGF pathway

43
Q

Definition of castrate resistant prostate cancer

A

Progression of disease despite castrate testosterone (<1.7nmol/L)

44
Q

Treatment of castrate sensitive prostate cancer

A

Androgen deprivation therapy

  • GnrH agonist (goserelin/leuprolide)
  • GnrH antagonists (degarelix)
  • Bilateral orchidectomy
  • Adjuvant: Docetaxel/Abiraterone
45
Q

Complication of GnRH agonists

A

Clinical flare phenomenon (spinal cord compression if spinal mets). Surge in LH –> increased testosterone
- Ensure you give with testosterone antagonists

46
Q

Treatment of metastatic castrate resistant prostate cancer

A

Chemotherapy: Docetaxel/Cabazitaxel
Androgen receptor targeted therapies: Abiraterone/Enzalutamide
Radiopharmaceuticals
Immunotherapy: Sipuleucl

47
Q

Side effects of taxanes therapies

A

MOA: Stabilises microtubules leading to death during mitosis

Docetaxel: Polyneuropathy/cytopenias/hypersensitivity
Cabazitaxel: Diarrhoea/neutropenia

48
Q

Mechanism of action of abiraterone

A

Inhibits adrenal and autocrine production of androgens (inhibits 17-alpha hydroxyls and c-17 20 lyase)
This leads to shunting to increased production of mineralocorticoids

49
Q

Adverse effects of abiraterone

A

Hypertension
Hypokalaemia
Peripheral oedema
Transaminitis

Need to administer with corticosteroids

50
Q

Adverse effects of enzalutamide

A

Cognitive side effects

Seizures

51
Q

Most common germline DNA mutation in patients with prostate cancer

A

BRCA2

52
Q

Most common type of renal cell cancer?

A

Clear cell renal cell cancer

- Commonly associated with aberration in VHL gene

53
Q

Mechanism of VHL driven Renal cell carcinoma

A

Increase hypoxia inducible factor –> angiogenesis

54
Q

Risk factors for bladder cancer

A

Urothelial: Smoking

Non-urotherlial: Schistosomiasis

55
Q

Treatment of metastatic bladder cancer

A

Platinum based/Gemcitabine

56
Q

Cisplatin adverse effects

A

Nephrotoxicity (have to have a CrCl or >60)

Ototoxicity

57
Q

Which testicular cancer produces AFP?

A

Non seminomas

Nb: Beta HCG may be produced by both seminomas and non-seminomas.

57
Q

Which testicular cancer produces AFP?

A

Non seminomas

Nb: Beta HCG may be produced by both seminomas and non-seminomas.

58
Q

Testicular cancer

A

Orchidectomy

Exquisitely sensitive to chemotherapy: Carboplatin

58
Q

Treatment for seminoma

A

Orchidectomy

Exquisitely sensitive to chemotherapy: Carboplatin

59
Q

High risk seminoma

A

Tumor >4cm

Rete testis invasion

60
Q

Treatment for Non seminoma

A

Orchidectomy + Sruveillans

High risk: Add in BEP regimen

61
Q

Treatment for Metastatic melanoma with Braf mutation

A 
Immunotherapy: Nivolumab 
\+ 
Braf Inhibitor: Dabrafenib 
\+ 
MEK inhibitor: Trametinib
62
Q

Adverse effects of Dabrafenib

A

Fever - usually within in the first month of treatment
Cutaenous Squamous Cell Carcinoma and Keratoacanthoma - Can be excised while dabrafenib continues
Rash

63
Q

Bowel Cancer Screening

A

FOBT for those between 50-74 every second year

64
Q

Risk factors for Colon Cancer

A

Non-Modifiable: Previous abdominal radiotherapy and genetic risk predisposition (Lynch,
Modifiable: Obesity, Inflammatory Bowel disease, Diabetes and Insulin resistance, meat constipation.

65
Q

Colorectal cancer screening for moderate risk patients

A 
Moderate risk 
- 1st degree relative diagnosed <55
- 2 1st/2nd degree diagnosed at any age 
Screening 
- Colonoscopy every 5 years from age 50 or 10 years younger than ages of 1st diagnosis.
66
Q

Screening requirements for patient with FAP

A

Sigmoidoscopy from age 12-15
Total colectomy and ileorectal anastomosis
Duodenal screening from age 25 or time of colectomy

67
Q

Screening and management of Lynch Syndrome in relation to Colorectal cancer

A

Colonoscopy 1-2 yearly from age 25 or 5 years younger than familial case

Nb: MLH1 genetic subtype highest risk

68
Q

Treatment of stage 3 colorectal cancer (nodal spread)

A

Neoadjuvant chemotherapy with fluoropyrimidine as a radio sensitiser
Surgical resection
Adjuvant chemotherapy with fluoropyrimide and doublet with oxaliplatin

69
Q

Surveillance for colorectal cancer

A

6-12 monthly CT CAP for 3 years

CEA

70
Q

Adverse effects of 5-FU/Capcetibine

A

Coronary vasospasm

Planta Palmar Erythema

71
Q

Adverse effects of oxaliplatin

A

Peripheral Neuropathy
Pseudolaryngopharyngeal dysasthesia
Hypersensitivity reaction

72
Q

Targeted treatment of patients with KRAS wild type left sided colorectal cancer

A

Cetuximab/Panitumumab

73
Q

Targeted treatment of patients with right sided LRAS mutant colorectal cancer

A

VEGF inhibitor such as bevacizumab

RACP Written Exam 2021 (18 decks)

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