Oncology Flashcards
1
Q
pathophysiology of cancer
A
- cells become more and more abnormal or old
- damaged cells survive when they shouldn’t
- new cells from when are not needed (unstoppable division)
2
Q
drivers of cancer (genes)
A
- proto-oncogenes (involved in normal cell growth and division, if unregulated become oncogenes)
- tumour suppressor genes (involved in controlling cell growth and division, if down regulated, division uncontrolled)
- DNA repair genes (fix damaged DNA, cells with mutations in the genes tend to develop additional mutations)
3
Q
what is carcinoma forms from
adenocarcinoma, basal cell carcinoma
A
epithelial cells
adenocarcinoma; epithelial cells that produce fluid or mucus
basal cell: basal layer of epidermis
4
Q
what is sarcoma formed from
A
in bone and soft tissues of the body (including muscle, fat, blood vessels, lymph vessels and fibrous tissue)
5
Q
def adjacent treatment
A
treatment given after definitive treatment with aim to increase chance of cure
6
Q
def neoadjuvent treatment
A
given before main treatment to shrink/improve chance of cure
7
Q
def palliative treatment
A
improve quality of life where cure is not possible
8
Q
def radical treatment
A
treatment aim is to get rid of, or cure the disease
9
Q
def symptomatic treatment
A
relieve symptoms of cancer but not its cause
10
Q
def concurrent therapy
A
when 2+ therapies are given simultaneously
11
Q
def cycle
A
chemotherapy administered over few hours once every 2-3 weeks
allows for WCC and organ recovery
12
Q
def nadir
A
when WCC is low
in a sentence: FBC nadir
13
Q
def regimen
A
multiple drugs given together
14
Q
how is radiotherapy treatment broken down into
A
course of treatment, broken down into fractions (to allow for tissue recovery)
15
Q
how long is fraction of treatment of radiotherapy
A
15-30 mins
16
Q
SE of radiotherapy
A
(site dependent)
early:
fatigue, pain flare, esophagitis, pneumonitis (all the itis), skin reaction, diarrhoea, nausea, raised ICP, hair loss
late:
fibrosis, stricture, osteonecrosis, rib fracture, second malignancy
17
Q
types of radiotherapy
A
conventional
stereotactic
brachytherapy
proton treatment
18
Q
what are the different protocols to manage motion (in radiotherapy treatment)
A
- bladder protocol: empty bladder before treatment
- stomach: empty stomach/certain volume in stomach
- breath hold (for breast and lung)
- 4D CT scan
19
Q
why part of the cell division cycle does chemotherapy target
A
S (DNA synthesis) or M (mitosis) phases
20
Q
what are the different roles of chemotherapy
A
- curative (chemosensitive tumours)
- adjacent (reduce risk of relapse)
- radiosensitive (low dose to increase efficacy of radical radiotherapy)
- palliative
21
Q
route of administration for chemotherapy
A
IV oral intrathecal intra-arterial intravsicular intraperitoneal
22
Q
toxicity of chemotherapy (organ specific)
A
- bone marrow: neutropenia, thrombocytopenia
- GI: mucositis, D&V
- skin: alopecia, hand-foot syndrome
- heart: heart failure, angina/MI
- lungs: pulmonary fibrosis
- kidneys: renal impairment
- nerves: peripheral neuropathy, hearing loss
- reproduction: infertility
long term: cognitive impairment, increased chance of secondary cancers
23
Q
what are the different chemotherapy emergencies
A
- febrile neutropaenia/neutropenic sepsis
- thrombocytopaenic haemorrhage
- tumour lysis syndrome
24
Q
ECOG performance status
A
(highly correlated to survival)
0: fully active, able to carry out all pre-disease performance without restriction
1: restricted in physically strenuous activity but ambulatory and able to carry out light work
2: ambulatory and capable of all self care but unable to carry out any work activities (up and about for > 50 of waking hours)
3: capable of only limited self care. confined to bed/chair > 50% waking hours)
4. completely disabled and confined to bed/chair. no self care
5: deceased
25
presentation of lung cancer
- persistent cough
- haemoptysis
- dyspnoea
- chest pan
- hoarse voice
- stridor
- facial swelling
- finger clubbing
- lymphadenopathy
systemic:
- weight loss
- fatigue
- appetite loss
SIADH
26
when do you 2ww referral for lung cancer
- CXR suggestive of lung cancer
- > 40yo and unexplained haemoptysis
- offer CXR if > 40y and 2 of the following: smoker, cough, fatigue, SOB, chest pain, weight/appetite loss
- offer XCR if > 40y and 1 of following: persistent or recurrent chest infections, finger clubbing, supraclaviular lymphadenopathy, chest signs consistent wit lung cancer, thrombocytosis
27
investigations for lung cancer
- CXR
- blood tests (FBC, renal function, bone profile, liver function)
- pulmonary function tests (essential before treatment)
- CT scan (for staging)
- bronchoscopy and biopsy
- PETCT scan
- brain CT/MRI (for metastasis)
28
lung cancer complications
- metastasis: brain, liver, kidneys, pleura, bone, adrenal glands
- Horner syndrome (Pancoast Tumour)
- SVC obstruction
- Paraneoplatic syndrome
29
prognosis of lung cancer
1 year survival of 30%
30
types of lung cancer
```
small cell
squamous
adenocarcinoma
large cell
alveolar cell carcinoma
```
31
supportive care for cancer
- macmillan nurse/cancer charities
- symptoms control
- benefits
- discussion regarding life expectancy, place of death
- hospice (day or inpatient)
- DNAR/AaND (allow a dacntural death)
- social workers
- support groups
- psychosocial counselling
32
presentation of hypercalcaemia
'bone, moans and abdo groans' (if slow onset)
- nausea
- polydipsia/polyuria
- constipation
- confusion
- weakness
if sudden onset: palpitations
33
management of hypercalcaemia
- check PTH
- ECG
- IV fluids (normal saline 2-3 L)
- bisphosphonates: IV zolendronic acid (may not be required if asymptomatic)
- anti emetics
- review meds
- treat malignancy
34
presentation of brain mets
- raised ICP (headache, nauseas and vomiting, papilloedema)
- focal neurological signs (paresis of limbs, speech disorders/dysphagia, seizures, cerebellar signs, visual symptoms, personality changes, CN VI palsy)
- coma (late sign)
35
investigations for brain mets
- bloods (FBC, U&Es, calcium, LFTs, CRP))
- GCS and neuro exam each time you see them
- CT head
36
management of brain mets
- call neurosurgery (surgical, radiotherapy, chemotherapy)
- dexamethasone
- antiemetics/analgesia if needed
- anticonvulsants (if seizure activity)
- mannitol or/and ventriculo-peritoneal shunt (if raised ICP)
- tell patients they cannot drive and document it
37
causes of hypercalcaemia of malignancy
- tumour osteolytic effect on bone (bone metastasis or primary bone cancer)
- humoral PTHrP (from squamous cell lung cancer or renal cancer)
- ectopic PTH (ovarian cancer)
- increased vit D (lymphoma)
38
presentation of metastatic spinal cord compression
- progressive pain in spine (severe, unremitting, aggravated by straining, 'band like', nocturnal/preventing from sleeping)
- localised spinal tenderness
- neuro signs: radicular pain, limb weakness, difficulty walking, sensory loss, bladder/bowel dysfunction)
39
investigations/diagnosis of metastatic spinal cord compression
whole spine MRI within 24h of presentation (flat bed rest until imaging done)
40
management of metastatic spinal cord compression
- high dose dexamethasone
| - oncological assessment for treatment (radiotherapy, surgical or best supportive care)
41
oncological emergencies
- sepsis (neutropenic)
- bleeding
- tumour lysis
- acute leukaemia
- hyper viscosity
- hypercalcaemia
- hyponatraemia
- raised ICP
- DVT/PE
- thrombocytopenia
- spinal cord compression
- airway compromise
- SVCO
- bowel obstruction
42
different type of immunotherapy
- passive immunotherapy (enhances body's existing immune response) (i.e. immune checkpoints inhibitors)
- active immunotherapy ( directs body's immune cells to recognise, attack and destroy cancer cells) (i.e. vaccines)
43
name two types of immune checkpoints inhibitors
CTLA-4 inhibitors (iplimumab)
| PD-1 pathway inhibitors (nivolumab)
44
SE of immunotherapy
- infusion related reaction
- autoimmune reaction (-itis)/ worsening of autoimmune conditions
- fatigue
- rash/pruritis
- diarrhoea (mucus/blood) + abdo pain, nausea/vomiting
- sob, cough
- endocrinopathy
45
management of immunotherapy side effects
immunosuppression with corticosteroids
46
types of targeted therapy
- small molecules
| - monoclonal antibodies
47
name monoclonal antibodies
- rituximab
| - trastuzumab (herceptin)
48
what are different types of small molecules (used in targeted oncology therapy)
- cyclin-dependent kinase inhibitor
- proteasome inhibitor
- tyrosine kinase inhibitor
49
general moa of targeted therapy
interfere with specific proteins that help cancer spread and grow
50
se of targeted therapy
- diarrhoea
- rash, skin/hair discolouration, nail changes
- LFT abnormalities (including clotting)
- cytopenia
- high BP
- fatigue
- mouth ulcers
51
management of targeted therapy SE
withhold drug and reintroduce at lower level
52
Epidemiology of cervical cancer
- younger women affected (< 44yo)
| - second most common cancer in females
53
prognosis of cervical cancer
5 year relative survival is 67.8%
54
risk factors for cervical cancer
- age 45-49
- HPV infection (16 and 18)
- multiple sexual partners
- early onset of sexual activity > 18
- immunosuppression (ie transplant)
- HIV
- cigarette smoking
- COC
55
presentation of cervical cancer
- abnormal vaginal bleeding
- postcoital blessing
- mucoid or purulent vaginal discharge
- pelvic/back pain
- dyspareunia
- cervical mass or bleeding on examination
- menorrhagia
56
types of cervical cancer
- squamous cell
- adenocarcinoma
- adenosqumous carcinoma
- small cell cancer
57
staging of cervical cancer
FIGO
- stage 1: within crevix
- stage 2: spread to surrounding tissues
- stage 3: spread into surrounding structures of the pelvis
- stage 4: metastasis
58
treatment of cervical cancer
- surgery
- chemoradiotherapy (including bradytherapy)
- targeted cancer drugs
59
prevention of cervical cancer
- vaccination (girls age 12-13): protects you for 10y against HPV 16, 18 and genital warts 6 and 11
- screening (from 25+:): pap smear of endocervical canal
60
vaccination process for cervical cancer
- offered to girls aged 12-13yo (year 8)
- if < 15: 2 doses over 6-24 months period
- if > &5: 3 doses
61
against which HPV/warts does Gardasil vaccination protect you against
- HPV 16 and 18 an types 6 and 11 genital warts
62
how often do you screen for cervical cancer
- women aged 25-49: every 3 years
- women age 50-64: every 5 years
- > 65 if tests are abnormal
63
how is HPV transmitted
skin contact (mainly sexual activity)
64
trial phase 0 (nb of people, cancer type, main aims of trial, randomised?)
- small, often 10-20 people
- often lots of cancer types
- aim: testing low dose to make sure not harmful
- not randomised
65
trial phase 1 (nb of people, cancer type, main aims of trial, randomised?)
- small (approx 20-50 people)
- often lots of cancer types
- aims: finding out about side effects, and what happens to treatment in body
- not randomised
66
trial phase 2 (nb of people, cancer type, main aims of trial, randomised?)
- medium (tens of people, sometimes over hundred)
- usually one or two cancer types
- aim: finding out about side effects, and what happens to treatment in body
- randomised: sometimes
67
trial phase 3 (nb of people, cancer type, main aims of trial, randomised?)
- large (hundreds/thousands of people)
- usually one cancer type
- aim: comparing new treatment to standard treatment
- randomised ususallu
68
trial phase 4 (nb of people, cancer type, main aims of trial, randomised?)
- medium to large (variable)
- usually one cancer type
- aim: finding out more about long term side effects and benefits
- randomised: no
69
in order to qualify to take consent for clinical trials, you must
- communicate effectively (including complex medical concepts)
- understand alternatives that are available
- understand how to avoid undue influence in devision making
- understand protocol and implications this may have on people involved
70
what key information must be given to patient when discussing clinical trial
- they can withdraw at any time (if do, may need follow up/monitor due to SE)
- standard therapy is available if they do not enter clinical trial
- all info needed to make informed decision
- entry in clinical trial is entirely voluntary and refusal does not affect care
- details of treatment an follow up
71
what are the common terminology criteria for adverse events (CTCAE)
Grade 1: asymptomatic or mild
Grade 2: moderate or affect instrumental ADLs
Grade 3: severe and affecting self care ADL
Grade 4:: life threatening
Grade 5: death
72
different types of trials
- interventional (pilot/feasibility studies, prevention, screening, treatment and multi-arm multi-stage trials)
- observational (cohort, case control and cross sectional studies)
73
definition of neutropenic sepsis
neutrophil count < 0.5*10(9)/L and T> 38°/signs/symptoms consistent with clinical significant sepsis
74
when is neutropenic sepsis most likely to occur
7-14 days after chemo
75
how do you manage neutropenic sepsis
- treat empirically (even before blood results come back): piperacillin with tazobactam
- SEPSIS 6
can offer prophylaxis (fluoroquinolone)
