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Oncology whatever Flashcards

1
Q

What proportion of feb neuts are culture positive in the end?

A

10-25%

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2
Q

What proportion of feb neut infections are caused by endogenous flora?

A

80%

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3
Q

What are the most common gram positives that cause feb neut?

A

staph epidermis
staph aureus
enterococcus
strep

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4
Q

What are the gram negatives that usually cause feb neut

A

E coli
Klebsiella
Pseudomonas

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5
Q

What proportion of feb neut have in hospital mortality?

A

9%

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6
Q

What is the most common mechanism of spinal cord compression?

A

Extension of the tumour from vertebral body or pedicle

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7
Q

What is the best predictor of outcome in spinal cord compression?

A

Neurological function at the start of treatment

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8
Q

What are the most common tumours that cause SC compression?

A

Lung
Breast
Prostate
(lymphoma, myeloma)

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9
Q

In SC compression, you should always image…

A

THE WHOLE SPINE

one third have multilevel deposits

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10
Q

What is the treatment of SC compression?

A

10mg dex stat then 4mg QID
surgery best to stabilise spine
radiotherapy in sensitive tumours
chemo rarely indicated but good if very sensitive

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11
Q

Name some symptoms of SVC obstruction

A 
face and arm swelling
pressure sensation in head
dyspnoea
cough
hoarse voice
headaches
epistaxis

Often worse on bending forward or lying down

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12
Q

Treatment of SVC syndrome

A

remove CVAD if present and thrombus
anticoagulate if thrombus
no evidence for steroids or diuretics
chemo: SC lung ca, NHL, germ cell
Endoluminal stent: rapid and sustained sx improvement
radiotherapy can be given alone or with stent.

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13
Q

What are the mechanisms of hypercalcaemia in malignancy?

A

pTHRP released by tumour (80%)- usually SCC
paracrine stimulation of osteosclasts eg breast, MM
Vitamin D analogue secretion by tumour- NHL and HD

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14
Q

When do you use bone modifying agents in advanced cancer?

A

when you have mets in breast and prostate cancer
decrease time to first skeletal related event
Effect: improve bone pain but do not improve survival

less data in other cancers, not PBS funded, not used

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15
Q

What are the two main classes of bone modifying agents in cancer?

A

Bisphosphonate
RANKL inhibitor

BOTH GIVEN WITH VIT D AND CA

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16
Q

What are the toxicities of zoledronic acid?

A 
acute phase reaction
renal insufficiency - caution under 60, CI under 30
hypocalcaemia
ON jaw
occular inflammation
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17
Q

Denosumab MOA

A

Inhibit RANKL–>inhibition of osteoclast activation

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18
Q

How is denosumab given?

A

Monthly subcut

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19
Q

Denosumab toxicities

A 
hypocalcaemia (more than ZA)
ON jaw (same risk as ZA)

not renally cleared so no need to monitor renal function

might be better than ZA in delaying first SRE in breast and prostate ca

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20
Q

If you get chest pain during Flurouracil and capcitabine what is it from

A

probably coronary artery spasm
not predictive if have pre-existing cardiac disease
plan: stop drug and do not re-challenge

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21
Q

What pulmonary toxicity is associated with the taxanes

A

diffuse intersitital pneumoinia
pulmonary oedema
pleural effusions

treat with cessation and steroids if severe

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22
Q

What pulmonary toxicity do erlotinib and gefitinib cause?

A

interstitial lung disease
higher risk if smoker, pre-existing lung disease
fatal in one third

23
Q

What cardiovascular side effect is known for Bevacizumab?

A

Hypertension- low risk of heart failure

24
Q

What are the cardiac toxicities with Sorafebib/Sunitinib

A

Reduced LVEF, rarely clinical heart failure

Re-challenge is feasible if have to stop agent

25
Q

Cisplatin: describe the neuroloogical side effects

A

peripheral neuropathy

  • glove and stocking sensory loss due to damage to DRG
  • no treatment once established
  • stop drug if functional impairment
  • usually reversible

Also get ototoxicity with tinitus and high frequency hearing loss

26
Q

Does carboplatin cause neurotoxicity?

A

Yes but much less often than with cisplatin and only at very high doses.

27
Q

What neurological side effects are seen with oxaliplatin?

A

Acute neurotoxicity

  • cold induced paresthesias and dysthesias hands and feet
  • pharyngolaryngeal dysthesias
  • may get jaw tightening or cramps
  • avoid cold stimulus
  • reversible

Chronic neurotoxicity with peripheral neuropathy glove and stocking distribution

28
Q

What are the neurological side effects seen with taxane chemotherapy?

A

nap-paclitaxel > paclitaxel >docetaxel >cabazitaxel
Glove and stocking sensory neuropathy with loss of reflexes
motor function preserved
should delay or dose reduce if severe
reversible in half

29
Q

What are the chemo agents that can cause peripheral neuropathy?

A

Oxaliplatin
Cisplatin
taxanes
Vinka alkaloids eg vincristine

30
Q

What neurological side effect is associated with Bevacizumab?

A

Reversible posterior leukoencephalopathy syndrome
rare- headaches, confusion, visual change, seizures
Symmetrical white matter oedema in posterior cerebral hemispheres
Plan: stop drug and control hypertension and most will improve

31
Q

What are the three roles for CEA in colorectal Ca?

A
  1. Elevated pre-op levels confer a poor prognosis
  2. Use to monitor for relapse post resection
  3. Use to assess response of metastatic disease to treatment
32
Q

What is the role of Ca19.9 in pancreatic cancer?

A

Levels at diagnosis and post resection have prognostic value. Monitor for disease relapse post resection. Monitor for response to metastatic disease treatment.

33
Q

What are the roles of CA 15-3 and CEA in breast cancer?

A

Used ONLY to monitor response of metastatic disease in treatment.
NO ROLE for looking for disease relapse.
May flare as response to treatment starts.

34
Q

What are non breast cancer causes of elevated CA 15-3?

A

B12 def
thalassaemia
sickle cell disease
liver dysfunction

35
Q

What is the role of CA 125 in ovarian cancer?

A

In advanced disease, monitor the response to therapy.

36
Q

What are non ovarian causes of CA 125?

A 
heart failure
hepatic disease, ascites
renal diseaser
fibroids, endometriosis
breast, lung, pancreatic Ca
37
Q

What are the tumour markers in pure seminoma and non-seminomatous germ cell tumour and how do they compare.

A

beta HCG, AFP, and LDH.

  • In pure seminoma, the AFP is always normal
  • remainder of markers in both cases can be either normal or increased
  • beta HCG is increased in less than 20% of pure seminomas
  • beta HCG or AFP or both are increased in 80% of non-seminomatous GCT
38
Q

How does chromograninA compare with 5HIAA in neuroendocrine tumours

A

Less specific but more sensitive so better at looking for disease relapse after treatment

Can also monitor response to treatment

Also elevated in PPI use, renal disease, liver disease, atrophic gastritis IBD

39
Q

How is thyroglobulin used in differentiated thyroid cancer?

A

prognostication
Assess response to treatment
Monitor for disease recurrence

40
Q

What is the role of Calcitonin and CEA in medullary thyroid cancer?

A

pre-op levels have prognostic value
assess for residual disease post op
monitor response to treatment in advanced disease

beta blockers, PPI, steroids, renal failure, hypercalcaemia, goitre and autoimmune thyroiditis can give you benign elevations of calcitonin. Neuroendocrine, papillary and follicular thyroid tumours also.

41
Q

ECOG 0

A

Fully active, able to carry on all pre-disease performance without restriction

42
Q

ECOG 1

A

Restricted in physically strenuous activity but ambulatory and able to carry out
work of a light or sedentary nature, e.g., light house work, office work

43
Q

ECOG 2

A

Ambulatory and capable of all selfcare but unable to carry out any work
activities. Up and about more than 50% of waking hours

44
Q

ECOG 3

A

Capable of only limited selfcare, confined to bed or chair more than 50% of
waking hours

45
Q

ECOG 4

A

Totally confined to bed or chair, no self care, completely disabled

46
Q

Neutropaenic sepsis - what bugs?

A

> 80% endogenous flora

70% gram positive - staph epi most common

47
Q

What is empirical treatment for feb neut?

A

Haemodynamically stable-

  • Taz
  • If penicillin non life threat allergy- Cefepime or Ceftazidime
  • If penicillin life threat - Cipro + vanc

Haemodynamically unstable
-As above plus gent
+/- vanc

Suspect cellulitis or have a catheter in
-Vanc add

Features abdo infection or suspect C diff colitis and not using taz- add metronidazole

48
Q

Most common for cord compression

A

lung, breast, prostate, lymphoma, myeloma

49
Q

What is the benefit of using denosumab in skeletal mets?

A

Subcut and easy to give
Dont have to adjust for renal function

Beware can get profound hypocalcaemia if underlying vitamin D deficiency.

50
Q

Malignancies associated with EBV?

A

PTLD
Burkitt Lymphona (more than 95% of these in endemic areas, 15-20% in low incidence areas)
NHL especially in HIV (less than 15% in non HIV)
Nasopharyngeal CA (100%)
HL 50% cases
nasal angiocentric lymphoma in africa (all of these NK origin tumours)

51
Q

Over expression of P53 in head and neck squamous?

A

Poor prognosis

52
Q

Why give adjuvant chemo

A

eliminate micro mets

53
Q 
Overall survival
vs
median survival time
vs
mean survival time
vs 
disease free survival
vs 
time to progression
vs 
progression free survival
vs
time to treatment failure
A

time from randomisation to death from any cause
vs
point where half alive and half dead
vs
length time people alive divided by length of study –>gives AUC
vs
time from randomisation until recurrence tumour or death any cause
vs
time from randomisation to OBJECTIVE tumour progression (not including death)
vs
time from randomisation to objeective tumour progression OR death
vs
time from randomisation to discontinuation of treatment for any reason including disease progression, toxicity, death

Oncology (13 decks)

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