Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Imperial Medicine Year 3 > Oncology AS > Flashcards

Oncology AS Flashcards

1
Q

Familial Breast and Ovarian Cancer

A

~10% of breast Ca is familial
~5% is caused by BRCA1 or BRCA2 mutations.
- Both TSGs
- BRCA1: Breast Ca ~80%, Ovarian Ca ~40%.
- BRCA2: Breast Ca ~80%, male breast Ca + prostate cancer

May opt for prophylactic mastectomy and oophrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Familial Prostate Ca

A
  • ~5% of those with prostate Ca have +ve fam HX
  • Multifactorial inheritance
  • BRCA1/2 –> moderately increased risk.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Familial CRC

A
  • ~20% of those with prostate Ca have +ve Fam history.
  • Relative risk of CRC for individual with FH related to:
    Closeness of relative
    Age of relative when Dx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of familial CRC?

A
  • Familial Adenomatous Polyposis
  • HNPCC-> this is the most common by far
  • Peutz-Jehgers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is FAP?

A

Familial Adenomatous POlyposis

  • Mutation in APC gene on Chr 5
  • TSG
  • Promotes B-catenin degradation

Cells then acquire another mutation to become Ca (p53/kRAS).

  • AD transmission
  • ~100% risk of CRC by 50yrs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is HNPCC?

A

HNPCC is more common than the other 2 causes of colon cancer.

Familial clustering of cancers 
- Lynch 1: CRC
- Lynch 2: CRC + other Ca
Ovarian
Endometrial
Pancreas
Small Bowel 
Renal pelvis

Mutations iN DNA mismatch repair gene
AD transmission
Often Right-sided CRC
Present @ young age: <50yr.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Peutz-Jegher’s

A
  • AD transmission
  • Multiple GI hamartomatous polyps
  • Mucocutaneous hyperpigmentation
    (lips, palms).
  • 10/20% lifetime risk of CRC
  • Also increased risk of other Ca
    Pancreas
    Lung
    Breast
    Ovaries and Uterus
    Testes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oncological emergencies - Febrile Neutropenia?

A

PMN < 1x10^8

  • Isolation + barrier nursing
  • Meticulous antisepsis
  • Broad-spectrum Abx, anti-fungal, anti-virals -> piperacillin with tazobactam
  • Prophylaxis: co-trimoxazole.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oncological emergencies - Spinal Cord compression?

A

Presentation

  • Back pain, radicular pain
  • Motor reflexes and sensory level
  • Bladder and bowel dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of Spinal cord compression?

A
  • Usually extradural metastasis

- Crush fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations of spinal cord compression

A

Urgent MRI spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal cord compression management?

A
  • PO Dexamethasone 8mg BD
  • Discuss with neurosurgeon and oncologist
  • Consider radiotherapy or surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SVCO with airway compromise?

A

SVCO not an emergency unless there’s tracheal compression with airway compromise.

Start Dexamethasone and continue if CT shows SVCO. If dexamethasone is unsuccessful then other options inc radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of SVC compression?

A
  • Usually Lung Ca
  • Thymus malignancy
  • LNs
  • SVC thrombosis: central lines, nephrotic syndrome
  • Fibrotic bands: Lung fibrosis after chemo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of SVC compression?

A 
Headache
Dyspnoea and orthopneoa
Plethora + thread veins in SVC distribution
Swollen face and arms
Engorged neck veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Pemberton’s sign?

A
  • Lifting arms above head for >1min –> facial plethora, increased JVP and inspiratory stridor
  • Due to narrowing of the thoracic inlet.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations of SVCO?

A

sputum cytology
CXR -> immediate ix
CT-> most useful for establising diagnosis
Venography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management for SVCO?

A
  • Dexamethasone (dex for malignancy, mannitol for everything else)
  • Consider Balloon venoplasty + SVC stenting
  • Radical or palliative chemo/radio.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hypercalcaemia in Oncology?

A

40% of those with myeloma
10-20% of those with Ca

Due to lytic bone mets
Production of PTHrP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptoms of Hypercalcaemia

A 
Confusion
Renal stones 
Polyuria and polydipsia
Abdo pain, constipation
Depression
Lethargy
Anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Investigations of Hypercalcaemia?

A
  • Increase Ca Often >3mm
  • Decreased PTH (key to exclude increased HPT)
  • CXR
  • Isotope bone scan.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of Hypercalcaemia?

A

Aggressive hydration

  • 0.9% NS
  • Monitor volume status
  • Furosemide when full to make room for more fluid.

If primary HPT excluded, give maintenance therapy - bisphosphonate: Zoledronate is good.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Other oncological emergencies?

A

Raised ICP

Tumour Lysis Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of cancer - Chemotherapy?

A

Cancer must be managed in an MDT

  • Neoadjuvant (Shrink tumour to decreased need for major surgery. Control early micromets.
  • Primary therapy (sole Management in haematological cancers)
  • Adjuvant
    decreased change of relapse e.g breast and GI cancer
  • Palliative
    Provide relief from symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cytotoxic Classes?

A 
Alkylating agents 
Antimetabolitis
Vinca alkaloids
Cytotoxic ABx
Taxanes 
Immune modulators 
MAbs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the alkylating agents

A

Cyclophosphamide, chorambucil, busulfan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the antimetabolities?

A

Methotrexate, 5-FU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the vinca alkaloids

A

Vincristine and Vinblastine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the cytotoxic antibiotics

A

Doxorubicin, bleomycin, actinomycin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the taxans?

A

Paclitaxel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the immune modulators?

A

Thalidomide

Lenalidomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does Trastuzumab treat?

A

anti-Her2 breast Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does Bevacizumab treat

A

Anti-VEGF: RCC, CRC, Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What does Cetuximab treat?

A

Anti-EGFR: RCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does Rituximab treat?

A

Anti-CD20 : NHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the TK inhibitors?

A

Erlotinib: Lung cancer
Imatinib: CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the endocrine modulators?

A

Tamoxifen

Anastrazole

38
Q

What are the common side effects of Chemo?

A

n/v
Alopecia
Neutropenia
Extravasation of chemo agent
- Pain, burning, bruising at chemo infusion site
- Stop infusion, give steroids, apply cold pack
- Liaise early with plastics.

39
Q

What specific problems does cyclophosphamide cause?

A

Hemorrhagic cystitis, myelosuppression, transitional cell carcinoma

Hair loss

BM suppression

40
Q

What specific problems does Doxorubicin cause?

A

Cardiomyopathy

41
Q

What specific problems does bleomycin cause?

A

Pulmonary Fibrosis

42
Q

What specific problems does Vincristine cause?

A

Peripheral neuropathy (reversible)

Paralytic ileus

Vinblastine: Myelosuppression

43
Q

What specific problems does Carboplatin cause?

A

Peripheral neuropathy
N/v
nephrotoxic

44
Q

What specific problems does paclitaxel cause?

A

Hypersensitivty

45
Q

What is Radial Radiotherapy treatment

A
  • Curative intent
  • 40-70Gy
  • 15-30 daily fractions
46
Q

What is palliation radiotherapy ?

A

Symptoms relief
- Bone pain, haemoptysis, cough, dyspnoea, bleeding

8-30 Gy

1-10 fractions.

47
Q

What are the early reactions to radiotherapy?

A 
Tiredness
Skin reaction: erythema --> ulceration 
Mucositis (painful ulceration and damage to mucous membranes) 
N/V
Diarrhoea 
Cystitis 
BM suppression
48
Q

Late reactions for radiotherapy?

A

Brachial plexopathy

  • follows axillary radiotherapy
  • Numb, weak, painful arm

Lymphoedema
Pneumonitis
- Dry cough ± dyspnoea
- manage: prednisolone

Xerostomia
Benign strictures 
Fistulae
Decreased fertility
Panhypopituitarism
49
Q

Surgery for cancer therapy

A

Diagnostics: tissue biopsy
Excision: GI, soft-tissue sarcoma, gynae

Palliation: Bypass procedure, stenting.

50
Q

What malignant cancers is AFP used for?

A

Hepatocellular carcinoma

Teratoma

51
Q

What non- malignant conditions is AFP a marker for?

A

Hepatitis
Cirrhosis
Pregnancy

52
Q

What malignant cancers is CA125 used for?

A

Ovary
Uterus
Breast

Should be part of a work up for non-specific abdo pain. Ovarian can fill much of the abdominal cavity. May be hard on a CT scan to convincingly identify primary.

Screen for FBC, U+E, LFTs, Calcium, Urinalysis, LDH, AFP, hCG.

53
Q

What non-malignant conditions is CA125 used for?

A

Cirrhosis

Pregnancy

54
Q

What malignant cancers is Ca15-3 used for?

A

Breast

55
Q

What non-malignant conditions is Ca15-3 used for?

A

Benign breast diseaase

56
Q

What malignant cancers is Ca19-9 used for?

A

Pancreas
Cholangiocarcinoma
CRC

57
Q

What non-malignant cancers is Ca19-9 used for?

A

Cholestatis

Pancreatitis

58
Q

What malignant cancers is Ca 27-29 used for?

A

Breast

59
Q

What malignant cancers is Neuron-Specific enolase used for?

A

SCLC

60
Q

What malignant cancers is CEA used for?

A

CRC - colorectal cancer

61
Q

What non-malignant conditions is CEA used for?

A

Pancreatitis

Cirrhosis

62
Q

What malignant cancers is B-HCG used for?

A

Germ cell tumours

AFP and HCG normally raised in non-seminoma but normal in seminoma

In non-seminomas (Teratoma) AFP is raised in 70% and hCG raised 40%. Man takes gfs pregnancy test and finds out he has a teratoma.

63
Q

What malignant cancers is PSA used for?

A

Prostate (non-malignant = BPH)

64
Q

What malignant cancers is mono Ig used for?

A

Multiple Myeloma

65
Q

What malignant cancers is S-100 used for?

A

Melanoma (benign in Sarcoma)

66
Q

What malignant cancers is PLAP used for?

A

Seminoma

67
Q

What malignant cancers is acid phosphatases used for?

A

Prostate

68
Q

What malignant cancers is thyroglobulin used for?

A

Thyroid cancer

69
Q

Bombesin

A

Small cell lung carcinoma
Gastric cancer
Neuroblastoma

70
Q

Spinal cord compression

A

Oncological emergency
- 5% of cancer patients. Extradural compression accounts for majority of cases.

  • Back pain, earliest and most common symptom. Worse on lying down or coughing.
  • Lower limb weakness
  • Sensory changes: sensory loss and numbness
  • Neuro signs depend on level of lesion.
  • Lesion above L1 usually result in UMN signs in the legs + sensory level.
  • Lesions below L1 usually cause LMN signs in legs + perianal numbness
  • Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion.

Management

  • High-dose oral dexamethasone
  • Urgent oncological assessment for consideration of radiotherapy or surgery.
71
Q

Irinotecan (Topoisomerase I)

A

Myelosuppression

72
Q

Cisplatin SE

A

Ototoxicity,
peripheral neuropathy,
Hypomagnesaemia

73
Q

Hydroxyurea SE

A

Myelosuppression

74
Q

Toxicity Bear?

A

A = Asparagine (neurotoxicity)

Cisplatin = ototoxicity/ nephrotoxicity - Tx = amifostine

Vincristine = Christ my nerves (peripheral neuropathy w/ vincristine), blast my bones (myelosuppression with vinblastine)

Bleomycin = Pulmonary fibrosis

Doxorubicin = Cardiomyopathy; tx = dexrozoxane

Cyclophosphomide = Nephrotoxicity, hypomagnesaemia, bladder toxic. Tx = democycline

Methotrexate: nephrotoxicity, (tx: leucovorin), myelosuppression (tx: filgrastim), oral mucositis, liver fibrosis

75
Q

Nivolumab MOA and use?

A

Immune checkpoint inhibitor = PD-1. Treatments for melanoma, Hodgkin’s lymphoma, NSCLC, uro cancers

76
Q

Ipilimumab MOA and use?

A

CTLA-4 (cytotoxic T lymphocyte-associated protein 4 for melanoma.

Given via injection/IV infusion.

77
Q

Atezolizumab, Avelumab, Durvalumab use?

A

PD-L1 - treat lung cancer and urothelial cancer.

78
Q

Side effects of checkpoint inhibitors?

A 
Dry, itchy skin and rashes (most commonly)
Nausea and vomiting
Decreased appetite
Diarrhoea
Tiredness and fatigue
Shortness of breath and a dry cough.

Immune related problems.

79
Q

Woman with bone mets causes?

A

Most likely to come from breast cancer.

Likelihood =
Prostate
Breast
Lung

Most common site

  • Spine
  • Pelvis
  • ribs
  • Skull
  • Long bones
80
Q

Most common cancers?

A
  1. Breast
  2. Lung
  3. Colorectal
  4. Prostate
  5. Bladder
  6. Non-Hodgkin’s lymphoma
  7. Melanoma
  8. Stomach
  9. Oesophagus
  10. Pancreas
81
Q

Most common cause of death from cancer?

A
  1. Lung
  2. Colorectal
  3. Breast
  4. Prostate
  5. Pancreas
  6. Oesophagus
  7. Stomach
  8. Bladder
  9. Non-Hodgkin’s lymphoma
  10. Ovarian
82
Q

For patients at low-ris of symptoms of nausea and vomiting?

A

Use metaclopramide

For high-risk patients - 5HT3 receptor antagonist such as ondansetron - especially if combined with dexamethasone.

For intracranial tumours -> dexamethasone

83
Q

Features of spinal mets?

A
  • unrelenting lumbar back pain
  • any thoracic/ cervical back pain
  • worse with sneezing, coughing or straining
  • nocturnal
  • a/w tenderness

If any neuro sx -> consider cord compression

84
Q

Commonest lung cancer in non-smokers?

A

Adenocarcinoma

  • typically peripheral
  • commonest cancer in non smokers
85
Q

Calcitonin a marker for?

A

Medullary thyroid cancer (MaiCa)

86
Q

Thyroglobulin a marker for?

A

Follicular/ papillary cancer (fthapad)

87
Q

Features of Gardner’s syndrome?

A
  • Autosomal dominant familial colorectal polyposis
  • Multiple colonic polyps
  • Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
  • Desmoid tumours are seen in 15%
  • Mutation of APC gene located on chromosome 5
  • Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer
  • Now considered a variant of familial adenomatous polyposis coli
88
Q

Features of Li Fraumeni syndrome?

A
  • Autosomal dominant
  • Consists of germline mutations to p53 tumour suppressor gene
  • High incidence of malignancies particularly sarcomas and leukaemias

Diagnosed when:

  • Individual develops sarcoma under 45 years
  • First degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age
89
Q

Features of lynch syndrome?

A
  • Autosomal dominant
  • Develop colonic cancer and endometrial cancer at young age
  • 80% of affected individuals will get colonic and/ or endometrial cancer
  • High risk individuals may be identified using the Amsterdam criteria

Amsterdam criteria
> Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
> Two successive affected generations.
> One or more colon cancers diagnosed under age 50 years.
> Familial adenomatous polyposis (FAP) has been excluded.

90
Q

Investigating an unknown primary?

A

NICE recommends the following investigations for all patients:

  • FBC, U&E, LFT, calcium, urinalysis, LDH
  • Chest X-ray
  • CT of chest, abdomen and pelvis
  • AFP and hCG

NICE recommends the following investigations for specific patients:

  • Myeloma screen (if lytic bone lesions)
  • Endoscopy (directed towards symptoms)
  • PSA (men)
  • CA 125 (women with peritoneal malignancy or ascites)
  • Testicular US (in men with germ cell tumours)
  • Mammography (in women with clinical or pathological features compatible with breast cancer)

Imperial Medicine Year 3 (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions