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APhase 3b flashcards > Oncology > Flashcards

Oncology Flashcards

1
Q

Definition of carcinogenesis

A

Transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations

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2
Q

Carcinogen definition

A

Mutagenic agent which causes cancer. (environmental, hormones, radiation)

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3
Q

Papilloma

A

Benign epithelial neoplasm of non-glandular, non-secretory cells.

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4
Q

Adenoma

A

Benign epithelial neoplasm of glandular or secretory cells.

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5
Q

Carcinoma

A

Malignant tumour of epithelial cells

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6
Q

Adenocarcinoma

A

Malignant tumour of glandular or secretory cells.

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7
Q

Sarcoma

A

Malignant connective tissue tumour

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8
Q

Metastatic cascade events

A

1) detachment
2) invasion
3) intravasation (blood or lymph)
4) evasion of the host’s defence system
5) adherence
6) extravasation
7) angiogenesis

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9
Q

Adverse effects of radiotherapy

A 
Fatigue
Diarrhoea
Nausea and vomiting
Erythema
Infertility
Lymphoedema
Hypothyroidism
Poor wound healing.
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10
Q

Adverse effects of chemotherapy

A

Mylosuppresion = Anaemia, Increased infections, bleeding.
Alopecia
Infertility
Nausea, vomiting and diarrhoea.
Fatigue
EXTRAVASATION when medicine leaks out of veins into surrounding tissue - pain, red, blisters.

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11
Q

Name some oncology emergencies

A 
Anaphylaxis to chemo agent.
Spinal cord compression
Neutropenic sepsis
DVT/PE
Hypercalcaemia of malignancy
Haemorrhage
SVC obstruction
Tumour lysis syndrome
Lambert-Eaton Myasthenic Syndrome
Carcinoid syndrome
Emergencies from paraneoplastic syndromes
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12
Q

Common malignancies to cause spinal cord compression

A 
Breast
Prostate
Lung
Myeloma
Lymphoma
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13
Q

S+S of spinal cord compression

A 
Severe, radicular back pain.
Weakness of limb
Sensory loss
Urinary retention, dribbling, incontinence.
Faecal incontinence.

O/E:
Pain and tenderness of local area.
Sensory and motor loss below level of compression.

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14
Q

Where does the spinal cord end and what happens if there is a compression below this level

A

L1

Cauda equina syndrome.

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15
Q

S+S of cauda equina syndrome/compression

A 
Sciatic pain (bilateral)
Bladder dysfunction (incontinence, retention)
Sacral or saddle paraesthesia
Loss of anal sphincter tone.
Gluteal muscle wasting and weakness.
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16
Q

Ix for spinal cord compression

A

START TREATMENT BEFORE ANYTHING!!

MRI of whole spinal cord

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17
Q

Mx of spinal cord compression

A

IV dexamethasone + PPI

Contact neurosurgery.

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18
Q

Definition of febrile neutropenia

A

Neutrophils = 0.5 x 10^9 per litre or lower
+
temperature higher than 38 degrees.

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19
Q

Ix for neutropenic sepsis

A 
START TREATMENT FIRST!!
Blood culture
FBC
U+E
ABG and lactate
LFT
CRP
Creatinine
Urine analysis
Clotting screen
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20
Q

Mx for neutropenic sepsis

A

Piperacillin + tazobactam.
IV fluid bolus
Monitor urine output.

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21
Q 
Differential diagnosis for patient presenting with:
Dyspnoea
Cough
Swelling of face and facial oedema.
Raised JVP
Collateral veins on chest
Cyanosis
A

Superior vena cava obstruction
Heart failure (JVP will pulsate)
Cardiac tamponade
External jugular vein compression.

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22
Q

Malignancies which are more likely to cause SVC obstruction

A

Involving medistinal lymph nodes e.g. NSC and SC lung cancers, non-hodkin’s lymphoma.

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23
Q

S+S of SVC obstruction

A

Dyspnoea
Cough
Swelling of face
Headache

O/E:
facial oedema and plethora
fixed raised JVP
collateral veins on chest wall
cyanosis
papilloedema
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24
Q

Ix for SVC obstruction

A

For many will be first presentation of the cancer so image to get clear diagnosis.
CXR or CT thorax.
US of upper extremities.

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25
Q

Mx of SVC obstruction

A 
If acute airway obstruction:
Secure airway (A-->E)
Radiotherapy
Dexamethasone.
Loop diuretic

Treat malignancy.
Endovascular stenting is a symptomatic/pallative option.

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26
Q

Causes of raised ICP in a cancer patient

A

Neoplasm e.g. glioma, meningioma)
Haemorrhage (increased risk of bleed from myelosuppresion)
CNS infection e.g encephalitis (myelosuppresion = immunocompromised)

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27
Q

S+S of raised ICP

A 
Headache
Nausea and vomiting
Worse on sneezing, coughing and in morning (after lying down).
Drowsy
Gait abnormality

O/E:
Papilloedema
Focal neurology signs

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28
Q

Ix of raised ICP

A

Head CT or MRI

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29
Q

Mx of raised ICP

A

High dose dexamethasone to reduce oedema for cancer cause only!!!.
Alternative to dex or for all other causes = Mannitol.
Contact oncology team :)
Consider neurosurgical intervention, chemotherapy.

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30
Q

When to intervene ASAP in hypercalcaemia

A

If free calcium is greater or equal to 3.0mmol/L.

31
Q

Aetiology of hypercalcaemia in cancer patients

A

Humoral = systemic release of factors which activate oestoclasts. e.g. secretion of parathyroid hormone in squamous cell carcinoma of lungs.
Osteolytic metastasise = increased bone resorption due to bone metastases e.g. breast, multiple myeloma and lymphoma + calcitriol production.
Over-production of 25-hydroxyvitamin D = tumour secretes osteoclast activating hormone e.g lymphoma
Dehydration

32
Q

S+S of hypercalcaemia

A

Bones - boney pains.
Moans - loss of appetite, nausea + vomiting, malaise, fatigue.
Stones - renal colic.
Thrones - polyuria, polydipsia, dehydration (dry mucus membranes, constipation).
Psych undertones - depression, cognitive dysfunction, drowsy.
Cardiac - arrythmias

33
Q

Ix in hypercalcaemia

A 
U+E
FBC
Albumin
Parathyroid hormone levels
ECG
Serum calcitriol and 25-hydroxyvitamin D
34
Q

Mx of hypercalcaemia

A

Rehydration - 0.9% normal saline resuscitation.
Monitor U+Es
Bisphosphonates e.g. Pamidronate
Loop diuretic e.g. furosemide to avoid overload.
If recurrent can use Denosumab (inhibits RANK ligand)

35
Q

Bisphosphonate to use in hypercalcaemia of malignancy

A

Pamidronate

36
Q

Tumour lysis syndrome pathophysiology

A

Combination of metabolic and electrolyte abnormalities occurring after cytotoxic treatment in patients with cancer.

Excessive cell lysis
Renal impairment

37
Q

Electrolyte imbalances in tumour lysis syndrome

A

Hyperuricaemia
Hyperphosphataemia
Hyperkalaemia
Hypocalcaemia

AKI
Metabolic acidosis

38
Q

S+S in tumour lysis syndrome

A 
Nausea and vomiting
Anorexia
Diarrhoea
Muscle cramps and weakness
Lethargy
Confusion
Haematuria, flank pain, oligouria/anuria
Arrythmia
Syncope
39
Q

Name of the definition of tumour lysis syndrome

A

Cairo-Bishop definition =
2 or more serum biochemistry results increase by 25% from baseline levels (uric acid, potassium, phosphate or calcium) occurring 3 days prior to treatment or 7 days after commencing treatment.

40
Q

Mx of tumour lysis syndrome

A

PROPHYLAXIS:
Optimise renal function pre-treatment.
Correct pre-existing electrolyte imbalances.
Adequate fluid intake - may use IV fluids and also loop diuretic to maintain high urine output.
Drugs = Allopurinol or if higher risk Rasburicase, these specfically help hyperuricaemia.

41
Q

Name a recombinant urate-oxidase enzyme used to manage tumour lysis syndrome

A

Rasburicase.

42
Q

Cancers commonly associated with paraneoplastic syndromes

A 
Lung (SC and NSC)
Pancreatic
Lymphoma
Breast
Prostate
Ovary
43
Q

SIADH as a paraneoplastic syndrome

A

Small cell lung cancer most commonly.
Inappropriate secretion of anti-diuretic hormone.
S+S: gait disturbance + falls, headache, nausea, muscle cramps, anorexia, seizures.
Ix: low sodium, high urine osmolality.
Rx: Fluid restriction, Demeclocycline antibiotics

44
Q

Cushing’s as a paraneoplastic syndrome

A

Inappropriate/ectopic overproduction of ACTH precursors.
Common malignancies = NC and NSC lung Ca, pancreatic, thymic.
High 24hr urinary cortisol.
High plasma ACTH
Poor dexamethasone suppresion test

45
Q

Hypercalcamia as a paraneoplastic syndrome

A

Bony metastases.

Tumour production of parathyroid hormone e.g squamous cell lung carcinoma (humour hypercalcaemia of malignancy) or TNF

46
Q

Hypoglycaemia as a paraneoplastic syndrome

A

Insulinoma

Non-islet cell pancreatic tumours secreting IGF-2.

47
Q

Lambert-Eaton myastheic syndrome

A

Decrease in pre-synaptic calcium dependent acetylcholine release.
Commonest malignancy = SCLC.
S+S = Insidious onset of fatigue, weakness and dry mouth, areflexia, diplopia, ptosis, impotence.
Ix = EMG, anti-P/Q voltage-gated calcium channel antibodies.
Rx = IV immunoglobulins

48
Q

Common neurological paraneoplastic syndromes

A

Peripheral neuropathy

Proximal myopathy.

49
Q

Hypo-osmotic, euvolemic hyponatraemia

A

SIADH secretion

50
Q

2 dermatology Paraneoplastic syndromes

A 
Acanthosis Nigricans (commonest = gastric adenocarcinoma)
Dermatomyositis
51
Q

Dermatomyosistis as a paraneoplastic syndrome

A

Skin changes + proximal muscle weakness.
Skin changes = Heliotrope rash on eyelids, facial erythema, phalangeal scaliness (similar to psoriasis).
Ix = High creatinine phosphokinase, EMG, mule biopsy.

52
Q

Haematological Paraneoplastic syndrome

A

Polycythaemia due to Erythropoietin secretion of tumour. Commonly renal malignancies.

53
Q

Carcinoid syndrome

A

Neuroendocrine tumours secrete serotonin and other vasoactive peptides (histamine etc).
S+S: flushing, diarrhoea, bronchial constriction (wheeze, SOB), RHF, abdomen cramps, palpitations.
Ix: high 5-HIAA, Chromogranin A.
Rx: surgical. Somatostatin analogue e.g. Octreotide

54
Q

Staging of gynae cancers

A

FIGO

55
Q

Staging of lymphoma

A

Ann Arbor classification

56
Q

Staging of colon cancer

A

TMN or Duke’s Classification

57
Q

Examples of staff in a cancer MDT

A 
Medical oncologist
Clinical/radiation oncologist
Pallative care team
Dietician
Physio
OT
Psychologist
Cancer nurses
58
Q

Symptom management for pain

A

Analgesia

59
Q

Symptom management for nausea

A

Metoclopramide

Ondansetron

60
Q

Symptom management for anorexia

A

Steroids e.g. prednisolone or dexamethasone

61
Q

Symptom management for cough

A

Opioids

62
Q

Cancers which commonly metastasise to bone

A 
Prostate cancer
Breast cancer
Lung cancer
Kidney cancer
Thyroid cancer
63
Q

Level of serum correct calcium for hypercalcaemia

A

Greater or equal to 2.6mmol/L

64
Q

What is corrected calcium?

A

As approximately 4% of calcium is bound to albumin need to account for that in serum levels.
Add 0.1mmol/L to calcium level for every 4g/L that albumin levels are below 40g/L

65
Q

Acute presentation of SIADH secretion treatment

A

Slow infusion of 1.8% NaCl

66
Q

What is Pemberton’s sign

A

Patient raises arms up to the sides of their face so that the arm touches the ear. Hold for 2-3mins.
+ve if: cyanosis, SOB or facial congestion occur on arm raise.
Indicates venous obstruction

67
Q

Normal ICP

A

<15mmHg

68
Q

Chemotherapy agent associated with reversible peripheral neuropathy

A

Vincristine and sometimes cisplatin

69
Q

Side effect of cisplatin

A

Ototoxicity and renal impairment

70
Q

The hallmarks of cancer

A 
Self-sufficiency of growth signals.
Evade apoptosis.
Insensitive to anti-growth factors.
Invasion and metastasis.
Limitless replicative potential.
Sustained angiogenesis.
71
Q

Purpose of adjutant therapy

A

Shrink tumour before surgery

Eradicate any residual micro tumour post surgery

72
Q

Tumour marker raised in pancreatic cancer

A

CA19-9

73
Q

Tumour marker raised in ovarian cancer

A

CA125

APhase 3b flashcards (16 decks)

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