palli/onc Flashcards
acanthosis palmaris
paraneoplastic
usually pulm or gastric origin
diagnosing AML
low Hb, neutrophils, platelets
raised WCC
blasts and Auer rods on film
> 20% blasts
AML treatment
cytarabine, idarubicin, daunorubucin
gemtuzumab ozogamicin (CD33)
midostaurin (FLT3)
supportive: hydroxycarbamide allopurinol rasburicase
diagnosing adrenal tumours
CT, MRI
MIBG scan- MIBG similar to adrenaline and taken up by neuroendocrine tumour
adrenal v sampling
adrenal tumour treament
alpha blockers then surgery for phaeochromocytoma
ketoconazole and metyrapone to reduce steroid
spironolactone to block aldosterone
mifepristone to block cortisol
tamoxifen to block oestrogen
mitotane for metastatic
pain ladder
- paracetamol
- ibuprofen or weak opioid
- 1 + 2
- paracetamol + alternative NSAID
- paracetamol + weak opioid
pain ladder for cancer pain
- non opioid +/- adjuvant
- opioid +/- 1.
- stronger opioid +/- 1
diagnosing aspergillosis
serum aspergillus galactomannan
serum 1-3 beta D glucan
halo sign (nodule), air crescent
ABPA- elevated IgE, aspergillus IgE and IgG
chronic- IgG
bladder ca treatment
non muscle invasive:
CIS, Ta, T1- resection TURBT and single shot mitomycin C intravesically
greater than 3cm- 6 shots
high risk G3T1 - 2x TURBT and intravesical BCG or radical cystectomy
muscle invasive:
radical cystectomy, ileal conduit
radical RTx
neoadjuvant cisplatin
metastatic: platinum chemo
CIN staging
CIN1- mild dyskaryosis
CIN3- high grade, full thickness, requires surgery
cervical cancer staging
1a, 1b confined to cervix
2 extends beyond uterus but not pelvic wall or lower 1/3 vagina
3 extends to pelvic sidewall or lower 1/3 vagina or hydronephrosis
4 beyond bladder/rectum
alkylating chemo
cyclophosphamide
inactivates enzymes involved in DNA production
s/e: haemorrhagic cystitis, pulm fibrosis
antimetabolite chemo
interferes with purine or pyramidine synthesis
MTX (hepatic failure, pulm fibrosis)
5FU (palmar plantar syndrome, cardiotoxic)
antibiotics as chemo
anthracycline- doxorubicin
s/e: CCF
bleomycin
s/e: pneumonitis, fibrosis, rash
mitomycin c
s/e: kidney failure, stomatitis, rash, alopecia
vincristine
inhibits spindle formation and mitosis
s/e: neuropathy, bronchospasm, blistering
paclitaxel
stabilises microtubules, inhibits mitosis
s/E: sudden total alopecia, myalgia, peripheral neuropathy
topoisomerase inhibitors
e.g. irinotecan
s/e: cholinergic syndrome, profuse diarrhoea
CLL cells
CD5, CD19, CD23 monoclonal B lymphocytes
diagnosing CLL
raised WCC
lymphocytosis > 5
smudge/smear cells on film
CD5, 19, 20, 23 on cytometry
CLL treatment
fludrabine + cyclophosphamide + rituximab 1st line
alkylating agents, purine analogues, ibrutinib second line
allogenic SCT for TP53 after remission
CML
BCR ABL chr 9, 22 philadelphia
mature myeloids, basophils and eosinophils on smear
granulocyte left shift
tx: tyrosine kinase inhib (imatinib)
allogenic SCT
MRI sequences for CNS tumours
T1: CSF low signal (dark)
T2: CSF high signal (white)
FLAIR: for periventricular
STIR
indications for stereotactic brain RTX
AVM lesions not amenable to coiling or clipping
vestibular schwannoma
mets
indications for brain metastectomy
patient is fit
symptomatic lesions is accessible
good prognosis of primary
indications for surgery for pituitary tumours
non functional with mass effects
cushings
acromegaly
acute visual deterioration
pituitary apoplexy
colorectal TNM
to- no evidence
tis- in situ
t1- submucosa
t2- muscularis mucosa
t3- subserosa or non peritonealised tissues
t4- other organs or structures or perforates visceral peritoneum
n1- 1-3 regional nodes
n2- 4 regional nodes
adjuvant chemo for stage 3 FUFA
colorectal cancer surgery abx prophylaxis
metro and cephalosporin at induction and 2 doses post op
indication for endometrial biopsy
> 4mm thickness
endometrial staging
FIGO
1: uterus body
2: uterus and cervix
3: beyond uterus within pelvis
4: bladder/bowel/beyond
endometrial ca treatment
internal/external RTX
progesterone if still wanting to conceive
CTx stage 3-4
hysterectomy:
stage 1- hysterectomy and BSO
stage 2-3- radical hysterectomy with nodes, cervix and top of vagina
stage 4- debulking
driving and seizures
inform after 1st episode
no driving for 6 months 1st seizure normal EEG
no driving for 12 months if abnormal
can drive if seizure free for 1y or nocturnal only for 3y
vocational or group 2 license requires seizure and antiepileptic meds free for 10y
gastric ca Lauren classification
diffuse: poorly differentiated, aggressive
intestinal type: well differentiated and slow growing, more common in men
first line antieplipetics
gen tonic clonic: valproate
focal: carbamaz
absence: ethosux
treating gastric ca
resection for T1/2
gastrectomy for > t2 or > N0
adjuvant chemo
trastuzumab for HER2 metastatic adenocarcinoma
triple therapy to eradicate h pylori
liver transplant criteria for liver ca
single tumour smaller than 5cm
no vasc or metastatic spread
AFP < 1000
treatment for cholangiocarcinoma
resection or transplant if unresectable at presentation
capecitabine post resection
CTx if inoperable:
Gem/Cis
FOLFOX second line
palliative stenting to relieve jaundice
diagnosing and treating hodgkins lymphoma
raised neutrophils, platelets, eosinophils, ESR, LDH
normocytic anaemia
LDH guides volume of disease
test for HIV
biopsy: reed sternberg
ABVD
BEACOPP
autologous SCT
adjuvant RTX for stage I or II
lung cancer treatment
NSCLC:
CTX for stage 2/3 or not suitable for surgery
RX if surgery not suitable or can’t tolerate CTX
ablation for primary and secondary lung ca
photodynamic therapy for localised inoperable endobronchial ca
SCLC:
surgery for early stage
CTX +/- RTX for limited stage
CTX for extensive stage
repeat CTX for recurrence
RTX for palliation
lung ca paraneoplastic syndromes
SCLC: lambert eaton, ACTH, SIADH
squamous: PTH and bony mets, TSH
large cell: gynaecomastia
adenocarcinoma: gynaecomastia, HPOA- periostitis, clubbing, arthritis
BRCA1 and 2
BRCA1: chr 17 long arm, auto dom. assoc w/ female breast, ovarian, prostate, colon
BRCA2: chr 13 long arm. assoc w/ breast, ovarian
indications for CTX for breast ca
premenopausal
lymph node positive
ER negative
grade III
large tumour
lymphovascular invasion
benefits of neoadjuvant:
monitor response and optimise CTx regime
reduce size to allow breast conserving surgery
indications for mastectomy
> 4cm or multifocal or central
NHL treatment
CHOP or FCR CTX
MTX + dex for primary CNS lymphoma
pancreatic cancer treatment
neoadjuvant chemo if borderline resectable
adjuvant gemcitabine + capecitabine
folfirinox or gemcitabine or oxiplatin for metastatic
peutz jeghers
auto dom STK11 chr 19
perioral and mucosal pigmentation
GI hamartomatous polyps
GI, pancreas, lung, breast, thyroid, uterus, ovaries, testes malignancy
2 yearly colonoscopy > 25y
prostate ca diagnosis
transrectal ultrasound with 10-12 random biopsies
MRI for staging
prostate ca staging
T1- clinically unapparent
T1a- incidental finding at TURP
T1b- incidental at TURP, > %5 tissue resected
T1c- identified on biopsy due to PSA
T2- palpable, confined to prostate
T2a- half a lobe or less
T2b- > half a lobe
T2c- both lobes
T3 extracapsular extension
T4 adjacent structures beyond seminal vesicles
Gleason grading 2 areas out of 5
prostate ca treatment
T1 and 2 potentially curable
T3 and 4 considered advanced
radical RTX or prostatectomy
antiandrogens
LHRH antagonists
types of testicular ca
seminomas:
homogenous macroscopic appearance
sheets of clear cells
classic, anaplastic and spermatocytic
non seminoma GCT:
embryonal- glands or papules
yolk sac- schiller duval (look like glomeruli)
choriocarcinoma- look like cytotrophoblasts
teratoma
most have mixed pattern
stromal tumours and lymphomas
testicular tumour markers
AFP (non seminomas)
BHCG (mostly non seminomas)
LDH (non specific)
PLAP (seminomas)
testicular ca treatment
radical orchidectomy
metastatic NSGCT: BEP CTX, resect residual masses
seminoma: carboplatin single dose post op
seminoma w/ mets: RTX +/- CTX
tumour lysis syndrome
raised urea, potassium, phosphate
tx:
IV fluids
allopurinol (won’t treat hyperuricaemia)
urate oxidase (to treat hyperuricaemia)
sodium bicarb
calcium
dialysis
febuxostat
NSE tumour marker
SCLC
neuroblastoma
ca 19-9 cancers
pancreas
bowel
lung
gall bladder
