General Oncology Flashcards

1
Q

ECOG score

A
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2
Q

Agents for fracture risk reduction in malignancy

A
  • Denosumab better than placebo, zoledronic acid and pamidronate at reducing risk of fractures in those with cancer
  • Denosumab:
    • Can be used in renal impairment
    • Higher risk of hypocalcaemia
    • Increases risk of skin infection
    • Similar risk to zoledronic acid at causing osteonecrosis of jaw
  • All monthly injections
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3
Q

Mechanism of action aprepitant

A
  • Neurokinin-1 (NK-1) receptor antagonist
  • Used for delayed chemotherapy nausea usually in combination with ondansetron and dexamethasone
  • CYP3A4 inhibitor
    • Dexamethasone substrate of CYP3A4 → needs dose reduction when used with aprepitant to prevent toxicity
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4
Q

Mechanism of action ondansetron

A
  • Serotonin (5-HT3) antagonist
  • Palonosetron - serotonin antagonist with highest affinity for the 5-HT3 receptor
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5
Q

Summary of the cell cycle

A
  • G0 → resting, cell exists in a quiescent state
  • Interphase: preparation for cell division. 3 stages:
    • G1 → starts with end of previous M phase until beginning of DNA synthesis → high metabolic rate, protein synthesis
    • S phase → DNA replication, when completed all chromosomes have been replicated
    • G2 phase → production of microtubules
  • M phase → division of cell into two daughter cells
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6
Q

Notes on Karnofsky performance scale

A
  • Correlates with survival in cancer
  • KPS <50% consistently suggests ife expectancy < 8 weeks for patients enrolled in palliative care programmes
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7
Q

Normalisation of which tumour marker predicts best overall survival?

A
  • AFP in testicular cancer

Normalisation in serum B-HCG within 2 weeks and AFP within 25-30 days suggests elimination of tumour → monitoring B-HCG and AFP most sensitive means of detecting early relapse

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8
Q

Malignancies that metatastasise to bone

A
  • Lung
  • Breast
  • Prostate

Lesions may be lytic or blastic

  • Prostate predominantly blastic
  • Lytic lesions → xray
  • Blastic lesions → radionuclide bone scans
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9
Q

Tumour lysis syndrome

A
  • Laboratory criteria → Hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia
  • Clinical criteria → increased serum creatinine, cardiac arrhythmia, seizure activity, sudden death
  • Associated with highly proliferative, bulky, chemosensitive malignancies
    • Lymphomas (Burkitts)
    • Leukaemias (ALL)
  • Risk factors:
    • Good treatment response
    • Pre-existing renal impairment or dehydration
    • High LDH
    • High WCC
  • Historically hyperuricaemia main mechanism of AKI in TLS → with urate lowering drugs main mechanism is now hyperphosphataemia and deposition of calcium phosphate (nephrocalcinosis)
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10
Q

Prevention of tumour lysis syndrome

A
  • Low risk → regular monitoring of biochemistry and assessment of fluid balance and vitals
  • Intermediate risk → IVF 2 days prior to chemo.
    • If urine output not satifactory despite volume repletion → loop diuretics (but caution as can cause precipitation of uric acid and calcium phosphate in tubules)
    • Allopurinol → prevents degradation purine → urate (contraindicated in combination with capecitabine)
    • Rasburicase if allopurinol fails
  • High risk → same as above and rasburicase from the start

Rasburicase transforms uric acid → allantoin (more soluble in urine than uric acid)

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