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Year 4 - OncologY > Oncology Blue Book - Part 1 > Flashcards

Oncology Blue Book - Part 1 Flashcards

1
Q

No. of ppl will be diagnosed with cancer?

A

1 in 3

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2
Q

No. of ppl will die of cancer in our generation

A

1 in 4

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3
Q

What are the Big 4 cancers

A

Breast, Lung, Prostate and GI tract

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4
Q

what cancer does cigarette smoke cause

A

lung cancer

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5
Q

Epstein Barr Virus cause what cancer

A

Burkitt’s lymphoma

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6
Q

What cancer is caused by a germline deletion of one allele of a gene and so mutation of the remaining allele –> carcinogenesis

A

neurofibromatosis, adenomatous polyposis coli and familiy breast cancer (BRCA 1 & 2)

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7
Q

which cancer leads to the discovery of p53

A

Li-Fraumeni syndrome

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8
Q

how does cigarette smoke cause cancer

A

causes specific mutation in the p53 tumour suppressor gene

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9
Q

where us aromatic amines commonly found

A

industrial dye

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10
Q

what do aromatic amines cause?

A

bladder cancer

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11
Q

where can you find benzene in

A

dye

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12
Q

what does benzene cause?

A

leukaemia

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13
Q

what does wood dust cause?

A

nasal adenocarcinoma

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14
Q

where can you find vinyl chloride

A

aerosol spray

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15
Q

what does vinyl chloride cause?

A

angiosarcoma

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16
Q

how does radiation cause cancer?

A

causes DNA damages anc accunumation of mutations in tumor-suppressor genes and oncogenes

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17
Q

what cancer does radiation causes

A

skin cancer

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18
Q

how does low fibre diet cause cancer

A

low fiber diet causes increase in transit time of food in the colon and so greater amount of carcinogens are absorbed this way

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19
Q

what does low fibre diet cause

A

colorectal carcinoma

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20
Q

what does smoke food cause

A

gastric carcnioma

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21
Q

what is topoisomerase

A

Topoisomerase = enzyme control changes in DNA Backbone by catalyzing the breaking & rejoining of phosphodiester backbone of DNA

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22
Q

an example of topoisomerase inhibitor

A

anti-cancer agent

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23
Q

what can topoisomerase cause

A

acute leukaemia

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24
Q

what cancer can human papillomavirus cause

A

cervical cancer

anal cancer

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25
Q

how can Human papillomavirus cause cancer

A

E6 protein by HPV16 binds to inactivate the p53 protein –> dysregulation of cell cycle and apoptotic pathways + malignant transformation of epithelial cells

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26
Q

what cancer can Epstein Barr Virus cause

A

non-Hodgkin’s Lymphoma

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27
Q

what can HBV cause

A

hepatocellular cancer

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28
Q

what cancer can retrovirus

A

HTLV1 (Human T-cell Leukaemia Virus Type 1)- T-cell lymphoma

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29
Q

What cancer can H. pylori cause

A

MALT - mucosal-associated lymphoid tissue tumours

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30
Q

How can infection/drug that causes weakening of the immune system cause cancer

A

immune system important in tumour survillance

weak immune system –> weak survillance and so cancer

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31
Q

what are some presenting symptoms of lump changes in cancer patient

A

breast lumps
change in moles
node, nodules and musclo-skeletal lumps

32
Q

what are some presenting symptoms of bleeding in cancer patient

A

rectal bleeding
haemoptysis
haematuria
post-menopausal/irregular menstrual bleeding

33
Q

what are some presenting symptoms of pain in the cancer patient

A

chest pain
abdo pain
headache
oftne unexplainable

34
Q

what are some presenting symptoms of change in function in cancer patient

A 
change in bowel habit, new cough 
dyspnoea
weight loss 
fever 
acute confusional state
35
Q

what is the purpose of staging

A

prognosis and appropriate choice of treatment

36
Q

what does higher staging means to a patient

A

more extensive the treatment has to be and probable systemic blood-norne metastases –> mets

37
Q

what is the general mechanism of action of chemotherapy

A

most agents targets DNA either directly or indirectly

toxic towards actively proliferating cells

38
Q

what is neoadjuvant chemotherapy

A

pre-operative treatment of an operable tumour before definitive surgery and also treat occult micro mets

aim to inc cure rate

39
Q

what is primary chemotherapy

A

initial chemo for a tumour that is inoperable or of uncertain operability

however reduction in tumour bulk in a pre-defined manner may make surgery with curative intent feasible

aim to inc cure rates

40
Q

what is adjuvant chemo

A

use of chemo following a complete macroscopic clearance at surgery to treat occult microscopic mets

aim to inc cure rate

41
Q

what is palliative chemo

A

aim to alleviate symptoms and prolong life in some cases in patient who can not be cured

42
Q

what is curative chemo

A

aim to cure cancer even if mets at presentation with modern chemo

example incl germ cells, Hodgkin’s disease, Non-Hodgkin’s Lymphona and childhood cancer

this justify the use of intensive chemo

43
Q

what is prophylactic chemo

A

hormonal treatments given before malignancy appears

example incl tamoxifen for in-situ breast cancer

44
Q

how is chemo usually given

A

as a combination of chemo medication

45
Q

why a combination of chemo drugs are given instead of only one

A

because multiple drugs can give synergism effect and may kill more cancer cells in a single cycle

also reduce the chance of medication resistance tumour cells to develop as different meds wrok in different sites of the cancer cells

46
Q

why is chemo given in cyles?

A

to allow normal cells to recover from the toxicity of treatment

47
Q

what cells are most commonly affected by the chemo

A

haematopoietic and gut lining –> myelosuppresion (low blood count)

48
Q

what is the usual effectiveness of a cycle of chemo drugs

A

roughly 6 months

49
Q

what justified the use of ‘high dose’ chemo

A

ehen long term survival or cure possible

50
Q

advantage of using drugs orally

A

to free patient from lengthy hospital visit or invasive procedure

51
Q

which chemo is available in oral form

A

cyclophosphamide
etoposide
tamoxifen
capecitabine

52
Q

how is systemic chemo given

A

usually bolus injection, short infusion

sometimes longer infusion via central line (PICC, central line or tunneled under the skin)

53
Q

which cancer warren a intra-vesical infusion of chemo

A

bladder cancer - by directly injecting chemo into the bladder, lower systemic absorption and higher local concentration = higher cure rate and less SE

54
Q

which cancer warren a intra-peritoneal infuision of chemo

A

Ovarian cancer - by injecting directly into the peritoneal cavity, chemo can stop trans-coelomical spread (spread within a cavity) of ovarian cancer

55
Q

which cancer warren an intra-arterial injection of chemo

A

Liver mets (direct injection in to hepatic artery) - this method of chemo injection only works for cancer which has a well-defined arterial supply.

56
Q

what is the commonly used way to calcuate the dose of a chemo drug

A

bodt surface area using the DuBois and DuBois formula

57
Q

which chemo drug has its dosage calculate using renal function

A

carboplatin

58
Q

which chemo drug has its dosage calculate using body weight

A

monocolonal antibody trastuzumab

59
Q

what is the first consideration when considering the start of chemo

A

SE vs potential benefit

60
Q

how can SE of chemo be divided into

A 
immediate = relevant to all patient
late = only concern those with long survival rate
61
Q

what are some examples of immediate side effects of chemo

A

Haemotology -
myelosuppresion

GI - 
N+V
oral mucositis 
diarrhoea 
colitis 
small bowel mu=coasal inflammation 
constipation

alopecia

Neuro - 
peripheral neuropathy 
autonomic neuropathy 
central neuropathy 
ototoxicity

nephrotoxicity
bladder toxicity

cardiac -
acute arrhythmia
coronary artey spasm
cardiac ischaemia

skin and soft tissue - 
extravasation 
palmar-plantar erythema 
photosensitivity 
pigmentation

allergic reaction
lethargy
myalgia and arthralgia

62
Q

how severe leucopenia is considered to be at risk of infection

A

neutrophil of 0.5x10 9 is considered at risk of infection but 1x10 9 is considered to be safe

63
Q

what is nadir

A

it is the lowest point of neutropenia induced by chemotherapy (10-14 days post chemo)

64
Q

how long does it take for the haematopoietic cells recover

A

3-4 wks

65
Q

which chemo drugs commonly cause neuropathy

A

cisplatin
taxanes eg docetaxel
vinca alkaloids - cytotoxic

66
Q

which chemo drug can cause CNS toxicity

A

isfamide-induced encephalopathy

5-Fu cerebellar toxicity

67
Q

which chemo drug can cause ototoxicity

A

cisplatin –> permanent

68
Q

which chemo drug can cause nephrotoxicity

A

cisplatin, ifosfamide

69
Q

which chemo drug can cause bladder toxicity

A

cyclophosphamide, ifosfamide

70
Q

which chemo drug can cause acute arrhythmia

A

Doxorubicin and paclitaxel

71
Q

whch chemo drug can cause coronary artery spasm

A

5-FU –> can further induce cardiac ischaemia

72
Q

which chemo drug can cause palmar plantar erythema

A

5-FU, capecitabine

targeted agents eg sunitinib, erlotinib

73
Q

which chemo drug can cause photosenitivity

A

5-FU

74
Q

which chemo drug can cause pigmentation

A

bleomycin

75
Q

which chemo drug has high frequency of allergic reaction

A

paclitaxel and docetaxel

76
Q

what are some late side effects of chemo

A 
secondary malignancies 
fertility 
pulmonary fibrosis/pneumonitis 
acute conduction defects 
psychological and social
77
Q

what can female cancer patient do to perserve her fertility

A

store fertilised ova

cryopreservation of sections of ovary

Year 4 - OncologY (4 decks)

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