Rando points Flashcards
Paraneoplastic antibodies: Anti CV2/CRMP5
Associated cancers - SCLC, Thymoma, other
Syndrome - Encephalomyelitis, cerebellar degeneration, chorea, peripheral neuropathy
Paraneoplastic antibodies - Anti Ma proteins
Associated Cancer - Testicular germ cell tumors, lung cancer, other solid tumors
Syndrome - Limbic, hypothalamic, brainstem encephalomyelitis (infrequently cerebellar degeneration)
Paraneoplastic antibodis: Anti-VGCC
Associated Cancer - SCLC
Other - Lambert Eaton myasthenic syndrome (50% will have malignancy)
Syndrome - Cerebellar degeneration
Paraneoplastic antibodies: Anti-amphiphysin
Associated Cancer - Breast, Lung
Syndrome - Stiff person syndrome, encephalomyelitis
Paraneoplastic antibodies: Anti-PCA2 (MAP1B)
Associated Cancer - SCLC
Syndrome - peripheral neuropathy, cerebellar ataxia, encephalopathy
Paraneoplastc antibodies: Anti-bipolar cells of the retina
Associated Cancer - Melanoma
Syndrome - Melanoma associated retinopathy
Which feature conveys the best prognosis in oropharyngeal cancer
HPV positive
Management of spinal cord compression in malignancy - draw
drug class and common toxicity
Biological effects and Normal Tissue Toxicity after radiotherapy
Tumour Suppressor involved in familial melanoma, glioblastoma and pancreatic Ca
CDKN2a
Drug profile: Cyclophosphamide
Taxane Chemotherapy
- mechanism of action
- 7 common side effects
Paraneoplastic antibodies: Anti-recoverin
Associated Cancer - SCLC
Syndrome - Cancer associated retinopathy
ECOG status
-Describe a patient at each level
Summary of Treatment of Advanced Testicular Cancer
Mechanism of CTLA-4
Up to how many brain mets and what size could you use stereotactic radiotherapy
4 mets all less than <4cm
Oncovirus - Malignancy
HCV (2)
HBV (1)
HPV (6)
EBV (4)
CMV (1)
HTLV (1)
HHV8 (2)
Li Fraumeni Syndrome
Rasburicase Drug Profile
Risk Factors of Tumour Lysis Syndrome
Malignancies with highest association with TLS
Brain Tumours
-Epidemiology and RFs
Recurrent Disease in Ovarian Ca
- ?benefit of Ca125 monitoring
- Platinum sensitivity definition and secondary agents
Oesophageal Ca: Risk Factors and Epidemiology
Oesophageal Ca - treatment of metastatic disease
Pancreatic Cancer: Risk Factors
Gallbladder Cancer: Summary
Gastrointestinal Stromal tumours - subtypes
- Which is most common
- Which gene mutation is most common
Management of HER2+ Gastric Ca (met)
Testicular Ca
Pathophysiology of Tumour Lysis Syndrome
Human Papilloma Virus Types and Association with Malignancy
HPV Vaccination
Diagnosis of Brain Tumour (Radiological)
-best modality and features of each
Treatment of High Grade Glioma
Oesophageal Ca: Treatment of Localised Disease
Gastric/GOJ Cancer: Risk Factors
Gastric/GOJ Cancer: Treatment
Pancreatic Disease: Determinants of whether it is resectable
Choliangiocarcinoma - Summary
Anal Cancer -Treatment and post treatment surveillance
GIST - Treatment
Immunotoxicity with , general principles and management
- what’s the most common reaction
- which reaction won’t respond to steroids
Higher incidence of immunotoxicity with CTLA4 inhibitor (ipilimumab)
Paraneoplastic antibody: Anti-Hu
Associated cancer - SCLC, others
Syndrome - Encephalomyelitis including cortical, limbic, and brainstem encephalitis; cerebellar degeneration; myelitis; sensory neuronopathy; and/or autonomic dysfunction
Paraneoplastic antibodies - Anti-Ri
CEA
- what’s it’s role (2)
- what common activity will give a false positive?
Pancreatic Ca: Treamtent
FOLFIRINOX is preferred but more toxic
Which chemo agent is the most gonadotoxic?
Alkalyting agents
Other - MTx
Paraneoplastic anti-bodies: Anti-Tr (DNER)
Associated Cancer - Hodgkin lymphoma
Syndrome - Cerebellar degeneration
Genetic Mutations associated with Lynch Syndrome
patients have autosomal dominant germline mutation in 1 of the following DNA mismatch repeair genes:
- MLH1
- MSH2
- MSH5
- PMS2 - lower penetrance than other genes
- EPCAM gene
Lynch syndrome patients have a germline mutation in one allele of a MMR gene 2nd allele is inactivated somatically by mutation, loss of heterozygosity or epigenetic silencing by promoter hypermethylation
- Muir-Torre syndrome: variant characterised by sebaceous tumors and cutaneous keratoacanthomas + normal ca associated with Lynch syndrome. MSH2 mutations seem to be particularly predisposed
Role of MESNA and cyclophosphamide
- used therapeutically to reduce the incidence of haemorrhagic cystitis and haematuria
- Ifosfamide or cyclophosphamide can be/may be converted to urotoxic metabolites such as acrolein
- MESNA assists to neutralise these metabolites by binding through its sulfhydryl-moieties and also increases urinary excretion of cysteine
Treatment of Bladder Cancer
Paraneoplastic antibody: Anti-Yo (Anti-purkinje cell)
Associated Cancer - Gynae, breast
Syndrome - cerebellar degeneration
Strongest RF for chemotherapy induced ovarian failure
Mechanism of PD-1 in Cancer and Immune Tolerance
What are the most common causes of infection in neutropoenic patients? Which subset are at risk of fungal pathogens?
- Most commonly by bacterial infection
- GPCs are the most common pathogens
- Common
- Staph epidermitis, by far the most common
- Staph aureus
- Streptococci
- Less common
- Corynebacterium, bacillus, leuconostoc, lactobacillus, propionibacterium acnes, rhodococcus
- GNBs used to be more common, but now account for only 10-20% of neutropoenic infections
- Generally associated with the most severe infections
- Increasing trend in multiresistant GNB infections
- Empiric broad cover is targeted at the small but significant risk of infection
- Fungal
- Candida and aspergillus spp account for most invasive fungal infections during neutropoenia
- Disseminated candidiasis with hepatosplenic involvement may not have symptoms until neutropoenia resolves
- Non albicans spp more common when fluconazole prophylaxis used
When is G-CSF use indicated? Is it of use in neutropoenic fever?
Primary prophylaxis
- Initiation of G-CSF during first cycle of myelosuppressive chemotherapy with the goal of preventing neutropoenic complications through all chemotherapy cycles
- May be used to allow for dose dense/intense strategies when reduction in density/intensity is known to be associated with poorer prognosis
- Indicated when anticipated incidence of neutropoenic fever is >=20%
Secondary prophylaxis
- Use of G-CSF in subsequent cycles when neutropoenic fever has occurred in a previous cycle
- Reduces incidence of subsequent neutropoenic fever by 50%
NOT recommended for routine use in those with established fever and neutropoenia
- Data show no change in overall mortality or infection related mortality
Filgrastim
- Start 24-72hrs post end of chemo and continuing until count reaches 5000-10000
Pegfilgrastim
- Start 24hrs post chemo and leave at least 14 days before next cycle
What is myeloid reconstitution syndrome? (In haem onc)
Onset or progression of an inflammatory focus that manifests at time of neutrophil recovery
- Defined clinically or radiologically
Need to consider superinfection
