Pass med onc Flashcards

1
Q

Most common tumours causing bone mets

A

prostate (most)
breast
lung

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2
Q

most common sites of mets

A

spine (most)
pelvis
ribs
skull
long bones

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3
Q

clinical fx of bone mets

A

bone pain
pathological fracturesb

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4
Q

blood tests of bone mets

A

raised ALP
hypercalcaemia

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5
Q

most common causes of cancer in UK

A
  1. Breast
  2. Lung
  3. Colorectal
  4. Prostate
  5. Bladder
  6. Non-Hodgkin’s lymphoma
  7. Melanoma
  8. Stomach
  9. Oesophagus
  10. Pancreas
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6
Q

most common causes of deaths from cancer in uk

A
  1. Lung
  2. Colorectal
  3. Breast
  4. Prostate
  5. Pancreas
  6. Oesophagus
  7. Stomach
  8. Bladder
  9. Non-Hodgkin’s lymphoma
  10. Ovarian
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7
Q

hepatocellular carcinoma carcinogen

A

aflatoxin (produced by aspergillus)

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8
Q

transitional cell carcinoma carcinogen

A

aniline dyes

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9
Q

mesothelioma and bronchial carcinoma carcinogen

A

asbestos

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10
Q

oesophageal and gastric cancer carcinogen

A

nitrosamines

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11
Q

hepatic angiosarcoma carcinogen

A

vinyl chloride

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12
Q

cervical cancer most important risk fx

A

Human papilloma virus

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13
Q

subtypes carcinogenic cervical cancer

A

16, 18, 33

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14
Q

subtypes non cancerous cervical cancer

A

6 and 11

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15
Q

non cancerous condition associated for cervical cancer

A

genital warts

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16
Q

histological fx of cervical cancer

A

endocervical cells undergo changes resulting in koilocytes, which appear like:
- enlarged nucleus
- irregular nuclear membrane contour
- nucleus stained darker
- perinuclear halo

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17
Q

common s/e of chemo

A

N+V

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18
Q

risk factors for development of N+V from chemo

A

anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used

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19
Q

N+V from chemo tx

A

low risk of sx - metoclopramide
high risk - ondansetron (esp if combined with dexamethasone)

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20
Q

cyclophosphamide indication

A

mx of cancer and autoimmune condition

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21
Q

cyclophosphamide s/e

A

haemorrhagic cystitis
myelosuppression
transitional cell carcinoma

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22
Q

cyclophosphamide mechanism

A

alkylating agent works by cross linking DNA

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23
Q

how reduce incidence of haemorrhagic cystitis in use of cyclophosphamide

A

Mesna:
2-mercaptoethane sulfonate Na binds to a metabolite of cyclophosphamide called acrolein which is toxic to urothelium…inactivating metabolite

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24
Q

bleomycin mechanism

A

degrades preformed DNA

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25
Q

bleomycin s/e

A

lung fibrosis

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26
Q

athracyclines (doxorubicin) mechanism

A

Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis

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27
Q

doxorubicin s/e

A

cardiomyopathy

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28
Q

methotrexate mechanism

A

Inhibits dihydrofolate reductase and thymidylate synthesis

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29
Q

methotrexate s/e

A

Myelosuppression, mucositis, liver fibrosis, lung fibrosis

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30
Q

flurouracil mechanism

A

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

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31
Q

fluorouracil s/e

A

Myelosuppression, mucositis, dermatitis

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32
Q

6-mercaptopurine mechanism

A

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

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33
Q

6-mercaptopurine s/e

A

myelosuppression

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34
Q

cytarabine mechanism

A

Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase

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35
Q

cytarabine s/e

A

myelosuppression, ataxia

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36
Q

vincristine mechanisms

A

inhibits formation of microtubules

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37
Q

vicristibine s/e

A

Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression

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38
Q

docetaxel mechanism

A

Prevents microtubule depolymerisation & disassembly, decreasing free tubulin

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39
Q

docetaxel s/e

A

neutropenia

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40
Q

irinotecan mechanism

A

inhibits topoisomerase I which prevents relaxation of supercoiled DNA

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41
Q

irinotecan s/e

A

myelosuppression

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42
Q

cisplatin mechanism

A

crosslinking of dna

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43
Q

cisplatin s/e

A

Ototoxicity, peripheral neuropathy, hypomagnesaemia

44
Q

hydroxyrurea (hydroxycarbamide) mechanism

A

Inhibits ribonucleotide reductase, decreasing DNA synthesis

45
Q

hydroxyurea s/e

A

myelosuppresion

46
Q

li fraumeni syndrome genetics

A

aut dom
germline mutations to p53 tumour supressor gene

47
Q

li fraumeni syndrome high incidence

A

sarcomas and leukaemias

48
Q

brca 1 and 2 gene which chromosome

A

brca 1 - chromosome 17
brca 2 - 13

49
Q

brca 1 and 2 associated risk

A

breast cancer
ovarian cancer
just brca 2 - prostate cancer

50
Q

lynch syndrome inheritance

A

aut dom

51
Q

lynch syndrome associated risk

A

colon cancer and endometrial cancer at young age

52
Q

lynch syndrome risk criteria

A

high risk individuals identified using amsterdam criteria

53
Q

amsterdam criteriab

A

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

54
Q

gardners syndrome genetics

A

aut dom familial colorectal polyposis
Mutation of APC gene located on chromosome 5
considered a variant of familial adenomatous polyposis coli

55
Q

clinical fx gardners syndrome

A

Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
Desmoid tumours are seen in 15%

56
Q

gardeners syndrome mx

A

most undergo colectomy as risk of colorectal cancer

57
Q

all pts investigations mets disease of unknown primary

A

FBC, U&E, LFT, calcium, urinalysis, LDH
Chest X-ray
CT of chest, abdomen and pelvis
AFP and hCG

58
Q

lytic bone lesions extra Inv

A

myeloma screen

59
Q

men extra inv mets

A

PSA
testicular US in men with germ cell tumour

60
Q

GI sx mets extra inv

A

endoscopy

61
Q

breast cancer mets extra inv

A

mammography

62
Q

3 main subtypes of non small cell lung cancer

A

squamous cell
adenocarcinoma
large cell

63
Q

squamous cell lung cancer fx

A

typically central
hypercalcaemia (PTHrP secretion)
finger clubbing
cavitating lesions
hypertrophic pulmonary osteoarthropathy

64
Q

adenocarcinoma lung cancer fx

A

typically peripheral
most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers

65
Q

large cell lung cancer fx

A

typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG

66
Q

spinal cord compression neoplastic how bad

A

oncological emergency

67
Q

majority cause of spinal cord compression

A

extradural compression from vertebral body mets

68
Q

most common primary cancer spinal cord compression

A

lung
breast
prostate

69
Q

clinical fx neoplastic spinal cord compression

A

back pain
the earliest and most common symptom
may be worse on lying down and coughing
lower limb weakness
sensory changes: sensory loss and numbness
neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

70
Q

investigations neoplastic spinal cord compression

A

urgent whole MRI scan within 24 hours

71
Q

neoplastic spinal cord compression mx

A

high dose oral dexamethasone
urgent oncological assesment for consideration f radiotherapy or sugrery

72
Q

PET scan how work

A

a form of nuclear imaging which uses fluorodeoxyglucose (FDG) as the radiotracer. This allows a 3D image of metabolic activity to be generated using glucose uptake as a proxy marker. The images obtained are then combined with a conventional imaging technique such as CT to decide whether lesions are metabolically active.

73
Q

uses PET scan

A

evaluating primary and possible metastatic disease
cardiac PET: not used mainstream currently

74
Q

sx of spinal mets (before compression)

A

Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness

75
Q

SVC obstruction how urgent

A

oncological emergency

76
Q

most common associated SVC obstruction

A

lung cancerc

77
Q

clinical fx SVC obstruction

A

dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

78
Q

causes SVC obstruction

A

common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis

79
Q

options for tx of SVC obstruction

A

endovascular stenting is often the treatment of choice to provide symptom relief
certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
the evidence base supporting the use of glucocorticoids is weak but they are often given

80
Q

tumour markers specificity

A

low generally

81
Q

CA-125

A

ovarian cancer

82
Q

CA 19-9

A

pancreatic cancer

83
Q

CA 15-3

A

breast cancer

84
Q

PSA

A

prostatic carcinoma

85
Q

AFP

A

hepatocellular carcinoma, teratoma

86
Q

CEA

A

colorectal cancer

87
Q

S-100

A

melanoma, schwannomas

88
Q

bombesin

A

small cell lung carcinoma, gastric cancer, neuroblastoma

89
Q

breast cancer ddx

A

fibrocystic, lipoma, fibroadenoma

90
Q

poor prog breast cancer

A

size
grade
BRCA 1/2 positive and er negaticvebr

91
Q

brca 1/2 genetic testing

A

<50 yrs and close relative, two or more close relatives with breast cancer

92
Q

colorectal genetics

A

sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis

93
Q

colorectal genetic referral meets crieteria

A

The Amsterdam criteria are sometimes used to aid diagnosis:
at least 3 family members with colon cancer
the cases span at least two generations
at least one case diagnosed before the age of 50 years

94
Q

colorectal screening

A

the NHS now has a national screening programme offering screening every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening

95
Q

pancreatic cancer associations

A

increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation

96
Q

pancreatic cancer ix

A

high-resolution CT scanning is the investigation of choice if the diagnosis is suspected
imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

97
Q

pancreatic cancer mx

A

a Whipple’s resection - rare (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
adjuvant chemotherapy is usually given following surgery
ERCP with stenting is often used for palliation

98
Q

renal cell carcinoma associations

A

more common in middle-aged men
smoking
von Hippel-Lindau syndrome
tuberous sclerosis
incidence of renal cell cancer is only slightly increased in patients with autosomal dominant polycystic kidney disease

99
Q

renal cell carcinoma mx

A

for confined disease a partial or total nephrectomy depending on the tumour size
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib)

100
Q

prostate cancer mx

A

radical prostatectomy (erectile dysfunction)
radiotherapy: external beam and brachytherapy (patients may develop proctitis and are also at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer)
GnRH agonists: e.g. Goserelin (Zoladex)
b/l orchidectomy
bicalutamide
non-steroidal anti-androgen
blocks the androgen receptor
cyproterone acetate
steroidal anti-androgen

101
Q

risk fx of testicular cancer

A

infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter’s syndrome
mumps orchitis

102
Q

testicular cancer presentation

A

a painless lump is the most common presenting symptom
pain may also be present in a minority of men
hydrocele
gynaecomastia
this occurs due to an increased oestrogen:androgen ratio
germ-cell tumours → hCG → Leydig cell dysfunction → increases in both oestradiol and testosterone production, but rise in oestradiol is relatively greater than testosterone
leydig cell tumours → directly secrete more oestradiol and convert additional androgen precursors to oestrogens

103
Q

testicular cancer mx

A

orchidectomy
radio or chemo

104
Q

hepatocellular carcinoma risk fx

A

hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis. Other risk factors include:
alpha-1 antitrypsin deficiency
hereditary tyrosinosis
glycogen storage disease
aflatoxin
drugs: oral contraceptive pill, anabolic steroids
porphyria cutanea tarda
male sex
diabetes mellitus, metabolic syndrome

105
Q

hepatocellular carcinoma xi

A

ultrasound (+/- alpha-fetoprotein)

106
Q

hepatocellular carcinoma mx

A

early disease: surgical resection
liver transplantation
radiofrequency ablation
transarterial chemoembolisation
sorafenib: a multikinase inhibitor

107
Q
A