Oncology - General

Question 1

Neo-adjuvant Chemo - Indications

Answer 1

Pre-operative

Make tumour smaller to decrease extent of surgery
Minimise occult metastasis

Question 2

Primary Chemo

Answer 2

Initial treatment if unoperable tumour

Question 3

Adjuvant

Answer 3

Following surgery

Treat occult mets

Question 4

Adjuvant - Used for what cancers?

Answer 4

Breast

Colorectal

Question 5

Palliative

Answer 5

Alleviation of symptoms, no intention of cure

Question 6

Curative - What cancers?

Answer 6

Germ cell

Hodgkins

Non-hodgkins

Question 7

Prophylactic Example

Answer 7

Tamoxifen for in situ breast cancer

Question 8

Three Principles of Chemo Combo Therapy

Answer 8

1. Different classes have different actions: synergism
2. less chance of drug resistance
3. Dose maintained due to differing toxicities in different drugs

Question 9

Chemo - Cycles

Answer 9

Every 3-4 weeks

Allows recovery of normal cells e.g. stem cells and GI tract

Question 10

Chemo - Treatment length

Answer 10

Max effectiveness = 6 months

Then resistance and increased toxicity

Question 11

Conventional Dose - Involves?

Answer 11

Outpatient setting, tolerable side effects

Use drug known to be toxic against specific Ca

Question 12

High Dose - Involves?

Answer 12

May need support e.g. bone marrow rescue

Justified if high chance of cure

Question 13

High Dose - Curative?

Answer 13

Hodgkin’s Disease

Ewing’s sarcoma

Question 14

Maintenance Chemo?

Answer 14

Only if good evidence

e.g. childhood leukaemia - for 18 months following remission

Question 15

Chemo - Oral Route

Answer 15

No hospital

Reduced toxicity

Only certain drugs

Question 16

Chemo - Oral Drugs

Answer 16

Cyclophosphamide

Tamoxifen

Question 17

Chemo - IV route

Answer 17

Majority

By infusion bolus

Lines - Central, tunnelled (PICC)

Question 18

Chemo - Regional examples

Answer 18

Intravesical - bladder Ca

Intraperitoneal - transcolaemic e.g. ovarian

Intra-arterial e.g. hepatic artery for liver mets

Question 19

Chemo - Dose calculation

Answer 19

Dubois and Dubois Surface area calculation

Carboplatin from renal function!

Question 20

Radiotherapy - Dose

Answer 20

Unit Gray (Gy)
Increased dose if radical treatment

Question 21

Radiotherapy - Factors affecting success

Answer 21

1. Treatment dose/total volume/overall treatment time
2. Comorbitities (diabetes IBD)
3. Radiosensitivity of tumour (Seminoma and hodgekins = very sensative)

Question 22

Delivery - GTV

Answer 22

Gross tumour volume

• Directly attacked

Question 23

Delivery - CTV

Answer 23

Clinical target volume

allows margin for microspread of tumour

Question 24

Delivery - PTV

Answer 24

Planned target volume

allows margin for patient movement

Question 25

RT - Total target area

Answer 25

Gross + Clinical + Planned target volume

Question 26

RT - Side Effects (Acute)

Answer 26

After 5-10 treatments, peaks following completion

Reversible but require management

E.g.

• Oral mucositosis
• Diarrhoea
• Local skin reaction (can be v. severe)

Question 27

RT - Side Effects (Chronic)

Answer 27

More than 3 months after course ends, maybe years
- irreversible and progressive

E.g.

• Lung fibrosis
• Skin atrophy
• Infertility

Question 28

RT - Malignancy Risk

Answer 28

Increased risk if good prognosis Ca, as higher dose given

Breast cancer = 4 in 10000 Ca after RT

Question 29

RT - In pregnancy?

Answer 29

Teratogenic, avoid!

Question 30

Bracytherapy

Answer 30

1. Intracavity
   - Uterus/cervix
2. Interstitial
   - Prostate, into tumour directly

Question 31

Radioisotopes

Answer 31

Radioactive iodine, thyroid Ca

• Selective to thyroid
• Must stay in lead room for protection of others

Question 32

Markers - CEA

Answer 32

Colorectal

Increased in
- Smokers, IBD, Hepatitis, Pancreatitis, Gastritis

Question 33

Markers - Ca-125

Answer 33

Ovarian Ca (82% will have high)

Raised in pancreatic, lung, colorectal and breast Ca.

Question 34

Markers - AFP

Answer 34

High in teratoma, hepatocellular Ca

• usually undetectable after age of 12 months

Question 35

Markers - bHCG

Answer 35

Non-seminomatous Ca

Question 36

Markers - PSA

Answer 36

Prostate Ca and BPH,

may rise in DRE, UTI etc.

Can be used to monitor response to treatment

Question 37

RECIST - Treatment response on imaging

Answer 37

CR - Complete response (no tumour seen)

PR - Partial (shrunk by >30%)

SR - Stable (increase <20, Decrease less than 30%)

PD - Progressive >20% increase or new lesions