Oncology Flashcards by Ben Young

List the main oncological emergencies

Spinal cord compression
Superior vena cava obstruction
Raised ICP
Hypercalcaemia

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What are some causes of spinal cord compression?

Extra-cordal compression (tumour)
Vertebral body extension (osteophyte)
Osteoporotic crush fracture

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List symptoms and signs of spinal cord compression

Back pain
Radicular (band-like) pain
Pain worse on cough/straining
Bowel/urinary change
Weakness
Altered sensation

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What investigations would you order for spinal cord compression?

Urgent MRI

Lumbar puncture if suspected meningeal involvement

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How is spinal cord compression treated?

Acute: IV dexamethasone
Surgery
Radio/chemo therapy

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List some causes of superior vena cava obstruction

Intrinsic: clot, foreign body, tumour
Extrinsic: mass/tumour, aneurysm, fibrosis
Thrombosis, ovarian hyper-stimulation

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List symptoms and signs of superior vena cava obstruction

Dyspnoea
Swollen face/neck/arms
Distended veins
Headache
Organomegaly
Non-collapsing veins

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What is Pemberton’s test for superior vena cava obstruction?

Lift arms over head

If causes facial plethora/cyanosis and raised JVP, obstruction is likely

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How is superior vena cava obstruction?

Clot - streptokinase, anticoagulation
Oral dexamethasone
Chemo/radio therapy
Stenting

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List causes of hypercalcaemia in oncological patients

Lytic bone mets
Myeloma
PTH-producing tumour

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List symptoms and signs of hypercalcaemia

Lethargy
Anorexia
Nausea
Polydipsia
Polyuria
Constipation
Confusion
Weakness
Moans, groans, aches and stones

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How is hypercalcaemia treated?

Manage underlying malignancy
Bisphosphonates
Calcitonin

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List symptoms and signs of raised ICP

Headache, worse in morning or straining
Nausea
Vomiting
Papilloedema
Fits
Focal neurological deficit

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What investigations would you order for raised ICP?

Urgent CT/MRI head

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How is raised ICP treated?

Dexamethasone PO
Radiotherapy
Surgery
Mannitol may give symptomatic relief

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What is meant by neoadjuvant chemotherapy?

Shrink tumour prior to surgery

Early control of metastasis

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What is meant by primary chemotherapy?

Sole treatment for malignancy

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What is meant by adjuvant chemotherapy?

Given post- surgery/radiotherapy to decrease risk of remission

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What is meant by palliative chemotherapy?

Given for symptomatic relief and prolong survival, i.e. non-curative intent

What do antimetabolic chemotherapy agents do? Name some?

Inhibit processes that promote growth/synthesis

Methotrexate, 5-fluoroucil, azathioprine

What do anti-tumour antibody chemotherapy agents do? Name some?

Inhibit DNA transcription and replication via topiromase inhibitors
Doxorubicin, etoposide, actinomycin

What do antimicrotubule chemotherapy agents do? Name some?

Prevent separation of chromatids during replication

Vincristine, vinblastine, paclitaxel

What do alkylating chemotherapy agents do? Name some?

Alkylate functional groups to form covalent bonds

Cyclophosphamide, chlorambucil, cisplatin, busulfan

What do monoclonal antibody chemotherapy agents do? Name some?

Target tumour-specific antigens

Rituximab (CD20), cefuximab (EGFR1), bevacizumab (VEGF), imatinib (TK1)

List some side effects of chemotherapy

``` Vomiting Alopecia Neutropenia Infertility Rash ```

How does radiotherapy work?

Uses ionising radiation to produce free radicals that damage DNA

Why is radiotherapy delivered in fractions?

Gives normal cells time to recover

What is the difference between radical and palliative radiotherapy in terms of the doseage given?

Radical - 40-70Gy in 15-35 fractions | Palliative - 8-30Gy in 1-10 fractions

List some early side effects of radiotherapy

``` Tiredness Skin reactions Mucositis, oral thrush Nausea, vomiting Diarrhoea Dysphagia ```

List some late side effects radiotherapy

CNS: somnolence, weakness, reduced IQ, plexopathy Lung: pneumonitis, cough, dyspnoea GI: dry mouth, strictures, inflammation GU: frequency, infertility, dyspareunia, vaginal stenosis Erectile dysunction, endocrine disturbance

List palliative drugs used for nausea and vomiting

``` Cyclizine (anti-histamine) Domperidone (blocks CTZ) Metoclopramide (anti-dopaminergic, pro-kinetic) Haloperidol (dopamine antagonist) Odansetron (5-HT antagonist) ```

List palliative drugs used for constipation

Bisacodyl | Movicol

List palliative drugs used for breathlessness

Oxygen Morphine (reduces resp drive) BZD's Pleurodesis, thoracocentesis

List palliative drugs used for dry mouth

Chew ice or pineapple Oral hygiene Pilocarpine

List palliative drugs used for itch

Cholesyramine | Ursodeoxycholic acid

List palliative drugs used for agitation/hallucinations

Haloperidol Quetiapine Midazolam

List palliative drugs used for excessive secretions

Buscopan (hyoscine hydrobromide)

List palliative drugs used for pain

Non-opioid (paracetamol, aspirin, NSAID) + weak opioid (codeine, dihydrocodeine, tramadol) + strong opioid (morphine, diamorphone, oxycodone, fentanyl)

What tumours cause raised AFP?

Hepatocellular carcinoma Germ cell tumour Also hepatitis, cirrhosis, pregnancy

What tumours cause raised CA 125?

Ovarian cancer Uterine cancer Breast cancer Hepatocellular carcinoma

What tumours cause raised CA 153?

Breast cancer

What tumours cause raised CA 199?

Colorectal cancer Pancreatic cancer Cholestasis

What tumours cause raised CA 2729?

Breast cancer

What tumours cause raised CEA?

``` GI cancer (esp colorectal) Also cirrhosis, pancreatitis, smoking ```

What tumours cause raised HER2?

Breast cancer Ovarian cancer Stomach cancer Uterine cancer

What tumours cause raised B-HCG?

Germ cell cancer Hydatiform mole Choriocarcinoma Also pregnancy

What tumours cause raised PSA?

Benign nodular hyperplasia of prostate | Prostate adenocarcinoma