Questions Flashcards
Roach Formula
PSA + ([Gleason score - 6] x 10)
If <13 = 7% Risk SV involvement
If ≥13 = 37% Risk SV involvement
ICRU 50 criteria for PTV dose
V95% (dose) = 100% (volume)
D100%(volume) ≥ 95% (dose)
Poor outcomes Myeloma
t(4;14)
t(14;16)
deletion 17p
Burkitt’s Lymphoma genetics
t(8;14)
Mantle cell lymphoma genetics
t(11;14)
MALT genetics
t(11;18)
Follicular lymphoma
t(14;18)
Indications for avoiding lymph node dissection in vulva
Clinically absent disease with <2cm diameter and <1cm stromal invasion
Treating Stage IA Endometrial
If adverse features >2 treat; >60, deep myometrial invasion or high grade
When is pelvic lymph node dissection indicated in melanoma?
If ≥2 nodes positive
When is chemotherapy indicated in spermatocystic seminoma?
If localised disease, no chemotherapy indicated as not associated with metastatic spread.
Thy3 cytology from Thyroid lesion
Indicates diagnostic hemi-thyroidectomy. Suspiscious of neoplasm
Thy3f (follicular - majority), Thy3a (atypia)
Where do the following originate primarily; Glioma Meningioma Ependymoma Choroid Plexus Papillomas Schwannomas
Glioma - above the tentorium Meningioma - from the dura peripherally Ependymoma - from the ventricle lining Choroid Plexus Papillomas - smaller than 4cm Schwannomas - Eight nerve
Lung:
Which mutations are associated with a good response to TKI therapy
Exon 19 deletion
Exon 21 missense L858R
associated with a good response to TKI therapy
Exon G719x mutations <5%, but also associated with TKI response
Lung: Which mutations are associated with resistance to TKI therapy
Exon 20 T790M point mutation
Exon 20 insertions
KRAS mutations
How to perform a melanoma biopsy
Excision with 2cm margin
Indications for post-op radiotherapy for submandibular tumours
High grade tumours Large >4cm Adenoid cystic Residual neck disease or microscopic ECS from lymph nodes Following surgery for recurrent disease
International Prognostic Score for Hodgkin’s disease
ALL MASH
Age ≥45 Leucocytosis >15x 10^9 Lymphopenia <8% or absolute <0.6x10^9 Male Albumin <40 Stage IV Haem <10.5
Good 0-1
Fair 2-3
Poor 4-7
How to correct for stand off
Inverse square law
I/I2 = D^2/D2^2
Indications for post-operative radiotherapy after hysterectomy for cervical cancer
Postive pelvic lymph nodes
Postive parametrial involvement
Close resection margins <5mm
Chronic Myeloid Leukaemia Genetic and Morphological characteristics
95% with CML, chromosomal translocation involving Chromosome 9 and 22
Fusion gene created by juxtapositioning Abl1 gene on chromosome 9 (region q34) to a part of the BCR gene on chromosome 22 (region q11).
The truncated chromosome 22 is known as the Philadelphia chromosome.
SCC genetics
CK6,7 and p63
Adenocarcinoma genetics
CDX-2 and CK20
RMI score
Predicts malignancy of ovarian mass based on ca125 (pre surgery), menopausal status and USS features
RMI = U x M x Ca125
U = 1
if; multilocular (septated) cyst, solid areas, bilateral lesions, ascites, intra-abdominal metastases.
U=3 if 2 or more features (RMI 1)
U=4 if 2 or more features (RMI 2)
M=1 if pre-menopausal
M=3 if post-menopausal (RMI 1)
M=4 if post menopausal (RMI 2)
RMI >200 Positive Predictive Value for malignancy of 70-80%
Myeloma ROTI (myeloma-related organ or tissue impairment)
CRAB
Calcium (adjusted) > 2.75
Renal insufficiency, Creatinine > 173
Anaemia, Hb <10 or >2g drop from lower limit
Bone, lytic lesions
Also indicated by symptomatic hyperviscocity, amyloidosis, recurrent bacterial infections. (RAS)
Myeloma ROTI (myeloma-related organ or tissue impairment)
CRAB
Calcium (adjusted) > 2.75
Renal insufficiency, Creatinine > 173
Anaemia, Hb <10 or >2g drop from lower limit
Bone, lytic lesions
Also indicated by symptomatic hyperviscocity, amyloidosis, recurrent bacterial infections. (RAS)
BCC post op radiotherapy
only indicated with involved margins
Melanoma Excision SLNB
SLNB indicated Stage IB and above
International Staging System (ISS)
3 risk categories for myeolma by [ ] B2 microglobulin and albumin
Serum B2 microglobulin <3.5 (296) and Serum Albumin >35
Neither I or III
Serum B2 microglobulin >5.5 (465)
Paraprotein level to differentiate MGUS and myeloma
<30g/l and <10% plasma cells in the bone marrow differentiate.
Presentation of Lymphoma;
Intestinal Mantle Cell Lymphoma
Burkitt’s Lymphoma
Intestinal Mantle Cell Lymphoma (Lymphomatous polyposis) - numerous polyps through the colon
Burkitt’s Lymphoma - Lymph node mass near the caecum
Ewing Sarcoma translocation
t(11;22)
Neutoblastomas genetics
Poor prognosis N-Myc amplification 17q gain (50%) 1p and 11q deletions 1q gain
Good Prognosis
Hyperdiploidy and triploidy
Treatment of ifosfamide encephalopaty
Methylene Blue
RF for oesophageal adenocarcinoma
predominantly GORD (rather than smoking and alcohol)
Percentages of SCC and AC in oesophagus
65% adeno, 25% scc
