Oncology+immuno Flashcards
What is the commonest cancer to metastatise to bone
Prostate
Commonest site for bone mets to occur
Spine
Three most common types of cancer in women in UK (and overall)
- breast
- lung
- bowel
Three most common causes of death from cancer in UK
- Lung
- Colorectal
- Breast
ovarian cancer blood tumour marker
CA125
CA 19-9
tumour marker for?
prostate cancer
CA 15-3
tumour marker for?
breast cancer
Alpha-feto protein (AFP)
tumour marker associated with…
hepatocellular carcinoma
teratoma
Carcinoembryonic antigen (CEA)
tumour marker associated with…
Colorectal cancer
S-100
tumour marker associated with…
melanoma
schwannomas
bombesin
tumour marker associated with…
small cell lung carcinoma
gastric cancer
neuroblastoma
what is the earliest and most common symptom of neoplastic spinal cord compression
back pain
worse on lying down and coughing
neurological signs of spinal cord compression depend on the level of the lesion. what kind of signs are seen in lesions:
(a) above L1
(b) below L1
(a) above L1 - UMN in legs, sensory level
(b) below L1 - LMN in legs, perianal numbness
Reflexes increase below level of lesion, and absent at level of lesion
Management of neoplastic spinal cord compression
- high dose oral dexamethasone
- urgent oncology review for radiotherapy or surgery
investigation of neoplastic spinal cord compression
whole MRI spine within 24 hours of presentation
which cytotoxic agent usually causes haemorrhagic cystitis
cyclophosphamide
which cytotoxic agents cause lung fibrosis
bleomycin
methotrexate
Chemotherapy side effects - what antiemetics to use
- If low-risk of symptoms, then metoclopramide
- If high-risk, then 5HT3 receptor antagonists e.g. ondansetron, especially if combined with dexamethasone
Which cytoxic medications can cause peripheral neuropathy
Vincristine (reversible)
Cisplatin
Three most common types of cancer in men in UK
- prostate
- lung
- bowel
Which cytoxic medications can cause peripheral neuropathy
Anthracyclines
e.g. doxorubicin
superior vena cava obstruction is caused by compression of the SVC, this is most commonly associated with what disease
lung cancer
superior vena cava obstruction features
SOB
swelling of face, neck, arms
headache
visual disturbance
pulseless jugular venous distension
Management of superior vena cava obstruction
- Endovascular stenting
- Malignancies may have radical chemo/radiotherapy
- Sometimes steroids are given
what type of hypersensitivity reaction occurs with anaphylactic reactions
Type I
Antigen reacts with IgE bound to mast cells
Antigen reacts with IgE bound to mast cells
what type of hypersensitivity is this
Type I
Anaphylactic
What combines in type II - cell bound hypersensitivity
IgG or IgM binds to antigen on cell surface
e.g. AIHA, ITP, Goodpasture’s
what binds in type III - immune complex hypersensitivity?
Free antigen and antibody (IgG, IgA) combine
SLE
post-strep glomerulonephritis
What is the mechanism of type IV - delayed hypersensitivity
T-cell mediated
e.g. GBS, graft versus host disease
What are the four types of hypersensivity and differences?
- Type I - anaphylactic (Ag with IgE)
- Type II - cell bound (IgG or IgM binds to Ag on cell surface)
- Type III - immune complex, free antigen and antibody (IgG, IgA combine)
- Type IV - delayed, T-cell mediated
what are the 3 main types of bladder cancers
- urothelial (transitional cell) carcinoma (>90%)
- squamous cell carcinoma
- adenocarcinoma
what type of staging does bladder cancer use
TNM staging
- patients undergo cystoscopy, biopsies or TURBT. regional spread is determined with MRI/CT scanning
Most patients (85%) with bladder cancer will present with
Painless macroscopic haematuria
Superficial lesions of bladder cancer may be managed using what in isolation
TURBT
If more spread, then surgery or radiotherapy is offered
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
- Aged 30 and over with unexplained breast lump
- Aged 50 and over with symptoms in one nipple only e.g. discharge, retraction etc
CONSIDER it >30 if they have skin changes or unexplained lump in axilla, or non-urgent referral if <30 with lump
hormonal therapy for prostate cancer aims to do what to hormones, and what are the options
aims to reduce androgen levels
- anti-androgen therapy
- with synthetic GnRH agonist or antagonist - bicalutamide - non-steroidal anti-androgen
- cryproterone acetate
- abiraterone
- bilateral orchidectomy
useful test for contact dermatitis
skin patch test
IM adrenaline doses for anaphylaxis
0-6 years
6-12 years
>12 years
0-6 years = 150mcg (0.15ml, 1:1000)
6-12 years = 300mcg (0.3ml, 1:1000)
>12 years = 500mcg (0.5ml, 1:1000)
can be repeated every 5 mins if necessary
where is IM adrenaline given for anaphylaxis
anterolateral aspect of middle third of thigh
refractory anaphylaxis is defined as what
resp and/or cardiovascular problems persist despite 2 doses of IM adrenaline
Give IV fluids for shock
serum tryptase can be raised in allergy up to how many hours after
up to 12 hours after
Discharge anaphylaxis patients with what criteria for each below:
(a) after 2 hours
(b) after 6 hours
(c) after 12 hours
(a) after 2 hours - good response to one dose of adrenaline, has epi-pen and supervision at home
(b) after 6 hours - 2 doses of adrenaline needed, previous biphasic reaction
(c) after 12 hours - severe reaction needing >2 doses of IM adrenaline, severe asthma, late at night or ongoing reaction
Skin prick testing can be read after what timeframe
after 15-20 mins
skin patch testing is 48 hours after patch removal
Radioallergosorbent test (RAST) determines the amount of what
IgE that reacts with allergens
