Oncology Blue Book - Part 1 Flashcards
No. of ppl will be diagnosed with cancer?
1 in 3
No. of ppl will die of cancer in our generation
1 in 4
What are the Big 4 cancers
Breast, Lung, Prostate and GI tract
what cancer does cigarette smoke cause
lung cancer
Epstein Barr Virus cause what cancer
Burkitt’s lymphoma
What cancer is caused by a germline deletion of one allele of a gene and so mutation of the remaining allele –> carcinogenesis
neurofibromatosis, adenomatous polyposis coli and familiy breast cancer (BRCA 1 & 2)
which cancer leads to the discovery of p53
Li-Fraumeni syndrome
how does cigarette smoke cause cancer
causes specific mutation in the p53 tumour suppressor gene
where us aromatic amines commonly found
industrial dye
what do aromatic amines cause?
bladder cancer
where can you find benzene in
dye
what does benzene cause?
leukaemia
what does wood dust cause?
nasal adenocarcinoma
where can you find vinyl chloride
aerosol spray
what does vinyl chloride cause?
angiosarcoma
how does radiation cause cancer?
causes DNA damages anc accunumation of mutations in tumor-suppressor genes and oncogenes
what cancer does radiation causes
skin cancer
how does low fibre diet cause cancer
low fiber diet causes increase in transit time of food in the colon and so greater amount of carcinogens are absorbed this way
what does low fibre diet cause
colorectal carcinoma
what does smoke food cause
gastric carcnioma
what is topoisomerase
Topoisomerase = enzyme control changes in DNA Backbone by catalyzing the breaking & rejoining of phosphodiester backbone of DNA
an example of topoisomerase inhibitor
anti-cancer agent
what can topoisomerase cause
acute leukaemia
what cancer can human papillomavirus cause
cervical cancer
anal cancer
how can Human papillomavirus cause cancer
E6 protein by HPV16 binds to inactivate the p53 protein –> dysregulation of cell cycle and apoptotic pathways + malignant transformation of epithelial cells
what cancer can Epstein Barr Virus cause
non-Hodgkin’s Lymphoma
what can HBV cause
hepatocellular cancer
what cancer can retrovirus
HTLV1 (Human T-cell Leukaemia Virus Type 1)- T-cell lymphoma
What cancer can H. pylori cause
MALT - mucosal-associated lymphoid tissue tumours
How can infection/drug that causes weakening of the immune system cause cancer
immune system important in tumour survillance
weak immune system –> weak survillance and so cancer
what are some presenting symptoms of lump changes in cancer patient
breast lumps
change in moles
node, nodules and musclo-skeletal lumps
what are some presenting symptoms of bleeding in cancer patient
rectal bleeding
haemoptysis
haematuria
post-menopausal/irregular menstrual bleeding
what are some presenting symptoms of pain in the cancer patient
chest pain
abdo pain
headache
oftne unexplainable
what are some presenting symptoms of change in function in cancer patient
change in bowel habit, new cough dyspnoea weight loss fever acute confusional state
what is the purpose of staging
prognosis and appropriate choice of treatment
what does higher staging means to a patient
more extensive the treatment has to be and probable systemic blood-norne metastases –> mets
what is the general mechanism of action of chemotherapy
most agents targets DNA either directly or indirectly
toxic towards actively proliferating cells
what is neoadjuvant chemotherapy
pre-operative treatment of an operable tumour before definitive surgery and also treat occult micro mets
aim to inc cure rate
what is primary chemotherapy
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
what is adjuvant chemo
use of chemo following a complete macroscopic clearance at surgery to treat occult microscopic mets
aim to inc cure rate
what is palliative chemo
aim to alleviate symptoms and prolong life in some cases in patient who can not be cured
what is curative chemo
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
what is prophylactic chemo
hormonal treatments given before malignancy appears
example incl tamoxifen for in-situ breast cancer
how is chemo usually given
as a combination of chemo medication
why a combination of chemo drugs are given instead of only one
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
why is chemo given in cyles?
to allow normal cells to recover from the toxicity of treatment
what cells are most commonly affected by the chemo
haematopoietic and gut lining –> myelosuppresion (low blood count)
what is the usual effectiveness of a cycle of chemo drugs
roughly 6 months
what justified the use of ‘high dose’ chemo
ehen long term survival or cure possible
advantage of using drugs orally
to free patient from lengthy hospital visit or invasive procedure
which chemo is available in oral form
cyclophosphamide
etoposide
tamoxifen
capecitabine
how is systemic chemo given
usually bolus injection, short infusion
sometimes longer infusion via central line (PICC, central line or tunneled under the skin)
which cancer warren a intra-vesical infusion of chemo
bladder cancer - by directly injecting chemo into the bladder, lower systemic absorption and higher local concentration = higher cure rate and less SE
which cancer warren a intra-peritoneal infuision of chemo
Ovarian cancer - by injecting directly into the peritoneal cavity, chemo can stop trans-coelomical spread (spread within a cavity) of ovarian cancer
which cancer warren an intra-arterial injection of chemo
Liver mets (direct injection in to hepatic artery) - this method of chemo injection only works for cancer which has a well-defined arterial supply.
what is the commonly used way to calcuate the dose of a chemo drug
bodt surface area using the DuBois and DuBois formula
which chemo drug has its dosage calculate using renal function
carboplatin
which chemo drug has its dosage calculate using body weight
monocolonal antibody trastuzumab
what is the first consideration when considering the start of chemo
SE vs potential benefit
how can SE of chemo be divided into
immediate = relevant to all patient late = only concern those with long survival rate
what are some examples of immediate side effects of chemo
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
how severe leucopenia is considered to be at risk of infection
neutrophil of 0.5x10 9 is considered at risk of infection but 1x10 9 is considered to be safe
what is nadir
it is the lowest point of neutropenia induced by chemotherapy (10-14 days post chemo)
how long does it take for the haematopoietic cells recover
3-4 wks
which chemo drugs commonly cause neuropathy
cisplatin
taxanes eg docetaxel
vinca alkaloids - cytotoxic
which chemo drug can cause CNS toxicity
isfamide-induced encephalopathy
5-Fu cerebellar toxicity
which chemo drug can cause ototoxicity
cisplatin –> permanent
which chemo drug can cause nephrotoxicity
cisplatin, ifosfamide
which chemo drug can cause bladder toxicity
cyclophosphamide, ifosfamide
which chemo drug can cause acute arrhythmia
Doxorubicin and paclitaxel
whch chemo drug can cause coronary artery spasm
5-FU –> can further induce cardiac ischaemia
which chemo drug can cause palmar plantar erythema
5-FU, capecitabine
targeted agents eg sunitinib, erlotinib
which chemo drug can cause photosenitivity
5-FU
which chemo drug can cause pigmentation
bleomycin
which chemo drug has high frequency of allergic reaction
paclitaxel and docetaxel
what are some late side effects of chemo
secondary malignancies fertility pulmonary fibrosis/pneumonitis acute conduction defects psychological and social
what can female cancer patient do to perserve her fertility
store fertilised ova
cryopreservation of sections of ovary
