Oncology +Palliation Flashcards
Bone metastases can present as –
pathological fractures
Most common tumour causing bone metastases
(in descending order)
Most common site (in descending order)
Other than bone pain, features may include:
pathological –
hyper–
raised –
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
Most common site (in descending order) spine pelvis ribs skull long bones
Other than bone pain, features may include:
pathological fractures
hypercalcaemia
raised ALP
– lung cancer has the strongest association with smoking
Squamous cell
There are three main subtypes of non-small cell lung cancer:
Squamous cell cancer typically -- associated with --- secretion → hyper--- strongly associated with --- hypertrophic pulmonary osteoarthropathy (HPOA)
Adenocarcinoma
typically —
most common type of lung cancer in —
although the majority of patients who develop lung adenocarcinoma are –
Large cell lung carcinoma
typically —
anaplastic, poorly differentiated tumours with a — prognosis
may secrete –
There are three main subtypes of non-small cell lung cancer:
Squamous cell cancer
typically central
associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia
strongly associated with finger clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
Adenocarcinoma
typically peripheral
most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers
Large cell lung carcinoma
typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG
Chemotherapy side-effects: nausea and vomiting
For patients at low-risk of symptoms then drugs such as — may be used first-line.
For high-risk patients then – receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone
Chemotherapy side-effects: nausea and vomiting
For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line.
For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone
– is associated with hypomagnesaemia
Cisplatin is associated with hypomagnesaemia
Alkylating agents
EG
MOA
SE- Haemorrhagic—, myelo—, —carcinoma
Alkylating agents
Cytotoxic Mechanism of action Adverse effects
Cyclophosphamide Alkylating agent - causes cross-linking in DNA Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
Cytotoxic antibiotics
Bleomycin Degrades preformed DNA SEx1?
Anthracyclines (e.g —) Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis SEx1?
Cytotoxic antibiotics
Bleomycin-Degrades preformed DNA -Lung fibrosis
Anthracyclines (e.g doxorubicin) Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis Cardiomyopathy
Antimetabolites
Methotrexate -Inhibits – reductase and thymidylate synthesis-
SE:? Myelo—, –itis, liver -, lung –
Fluorouracil (5-FU) — analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during - phase)
SE:? Myelo— –itis, –itis
Antimetabolites
Methotrexate Inhibits dihydrofolate reductase and thymidylate synthesis Myelosuppression, mucositis, liver fibrosis, lung fibrosis
Fluorouracil (5-FU) Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase) Myelosuppression, mucositis, dermatitis
– is used to suppress nausea and vomiting with intracranial tumours
Dexamethasone is used to suppress nausea and vomiting with intracranial tumours
1 - Ondansetron is a — receptor antagonist and is useful in —enteritis or –induced nausea.
2 - Haloperidol is an antipsychotic used as an —in palliative care
4 - Cyclizine is a —antagonist used to treat —induced nausea
5 - Metoclopramide is a —antagonist used to promote —
1 - Ondansetron is a 5HT-3 receptor antagonist and is useful in gastroenteritis or chemotherapy induced nausea.
2 - Haloperidol is an antipsychotic used as an anti-emetic in palliative care
4 - Cyclizine is a H1-antagonist used to treat inner-ear induced nausea
5 - Metoclopramide is a D2-antagonist used to promote bowel motility
Immune checkpoint inhibitor-Types:
Ipilimumab (Yervoy) is a checkpoint inhibitor that blocks -. It is a treatment for advanced –.
Nivolumab (Opdivo) and pembrolizumab (Keytruda) blocks –
These are treatments for —, — ,– lung cancer and — cancers.
Atezolizumab, Avelumab and Durvalumab block –and is used to treat — cancer and —cancer. It is also undergoing trials as a treatment for breast cancer.
Ipilimumab (Yervoy) is a checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte-associated protein 4). It is a treatment for advanced melanoma.
Nivolumab (Opdivo) and pembrolizumab (Keytruda) blocks PD-1 (programmed cell death protein 1). These are treatments for melanoma, Hodgkin’s lymphoma, non-small cell lung cancer and urological cancers
.
Atezolizumab, Avelumab and Durvalumab block PD-L1 and is used to treat lung cancer and urothelial cancer. It is also undergoing trials as a treatment for breast cancer.
Genetics and surgical disease
Li-Fraumeni Syndrome
Autosomal —
Consists of germline mutations to —–gene
High incidence of malignancies particularly —and –
Diagnosed when:
- Individual develops sarcoma under — years
- — degree relative diagnosed with any cancer below age – years and another family member develops malignancy under — years or — at any age
Li-Fraumeni Syndrome
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
Genetics and surgical disease
BRCA 1 and 2
Carried on chromosome – (BRCA 1) and Chromosome – (BRCA 2)
Linked to developing — cancer (60%) risk.
Associated risk of developing – cancer (55% with BRCA 1 and 25% with BRCA 2).
BRCA2 mutation is associated with – cancer in men
BRCA 1 and 2
Carried on chromosome 17 (BRCA 1) and Chromosome 13 (BRCA 2)
Linked to developing breast cancer (60%) risk.
Associated risk of developing ovarian cancer (55% with BRCA 1 and 25% with BRCA 2).
BRCA2 mutation is associated with prostate cancer in men
Genetics and surgical disease
Lynch Syndrome
Autosomal –
Develop – cancer and — cancer at young age
80% of affected individuals will get – and/ or – cancer
High risk individuals may be identified using the Amsterdam criteria
Amsterdam criteria
— or more family members with a confirmed diagnosis of— cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
— successive affected generations.
One or more – cancers diagnosed under age — years.
Familial adenomatous polyposis (FAP) has been excluded.
Lynch Syndrome
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.
