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Nimna's Flash Cards > Oncology > Flashcards

Oncology Flashcards

1
Q

SE unique to oxaliplatin

A

cold sensitive peripheral neuropathy

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2
Q

In stage 2 colorectal cancer, in which setting should you give adjuvant chemotherapy.

A

Give adjuvant therapy only if MSI stable. No benefit if MSI high

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3
Q

If a patient is T3N1 colorectal cancer, what chemo do they receive and what duration?

A

FOLFOX, CapeOX. 3 months

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4
Q

If a patient is T3N2 colorectal cancer, what chemo do they receive and what duration?

A

FOLFOX, CapeOX. 6 months

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5
Q

MOA of Cetuximab

A

EGFR inhibitor - works best in RAS wild type cancers

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6
Q

Pembrolizumab has most clinical benefit with what feature of CRC

A

MSI high tumors

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7
Q

Most common non CRC in Lynch syndrome

A

Endometrial cancer

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8
Q

The risk of triple negative breast cancer is greatest with which gene?

A

BRCA 1

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9
Q

Antibody related with highest risk for malignancy

A

Anti-TIF1-gamma

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10
Q

chemo agent most likely to cause infertility

A

cyclophosphamide

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11
Q

Chemo drug causing severe pain and tissue damage on extravasation

A

Doxorubicin

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12
Q

SE Bleomycin

A

Pulmonary toxicity

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13
Q

SE Doxorubicin

A

Extravasation reaction/ tissue necrosis Cardiotoxicity

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14
Q

SE Vinblastine

A

Peripheral neuropathy, neutropenia

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15
Q

SE Dacarbazine

A

GI toxicity

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16
Q

Enzyme which metabolises Capecitabine/ 5FU

A

Dihydropyrimidine dehydrogenase

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17
Q

Most common symptom in advanced cancer

A

pain

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18
Q

Most chemo resistant cancer

A

Renal cell

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19
Q

Biggest risk factor for ovarian failure with cyclophosphamide

A

Womans age - linear relationship between age and ovarian failure.

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20
Q

mantle radiotherapy is at highest risk of which cancer?

A

Breast cancer

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21
Q

Late onset toxicity of ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)

A

Hypothyroid MDS Infertility Cardiomyopathy

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22
Q

Pertuzumab MOA

A

Prevents HER2-HER3 dimerisation

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23
Q

AFP is high in which cancers

A

non-seminomatous cancers

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24
Q

bHCG is high in which cancers

A

seminomatous cancers (and a few non-seminomatous) Note all testicular cancers have high LDH.

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25
Q

Chemo causing SEVERE diarrhoea

A

5FU/Capecitabine

Irinotecan

Ipilimumab

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26
Q

Chemo causing cardiotoxicity

A

Doxorubicin (most) Trastuzumab TKI’s 5FU

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27
Q

Chemo causing acneform rash

A

EGFR inhibitors - erlotinib, gefitinib, cetuximab

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28
Q

Chemo causing Plantar-palmar hyperkeratosis

A

BRAF inhibitors (RAF makes them rough)

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29
Q

Chemo causing Palmar-plantar erythrodysaesthesia/ hand-foot syndrome

A

5FU/ Capecitabine TKI’s - sunitinib, sorafenib

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30
Q

Chemo agents which stop the cell cycle (list for each phase)

A

G0 - Nil

G1 - Tamoxifen, Doxorubicin. (Topoisomerase/DNA breaks)

S - Methotrexate, Gemcitabine, 5FU. (thymidalate/DNA synthesis)

G2 - Etoposide, Bleomycin (Topoisomerase/DNA breaks)

M - Taxanes, Vinca-alkaloids (microtubules)

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31
Q

Expression of what protein is required for Tamoxifen to suppress ERBB2/HER2

A

PAX2. (if PAX2 is low and AIB1 is high then it causes increased ERRB2 expression)

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32
Q

Highest risk factor in invasive breast cancer

A

Axillary node involvement

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33
Q

Management of chemo induced diarrhoea

A
  1. oral fluids 2. Loperamide 3. oral ABx 4. discontinue chemo/radio 5. stool specimen 6. IVT 7. IV ABx 8. Octreotide
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34
Q

2 types of Prostate cancer

A

Castrate sensitive Castrate resistant

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35
Q

Management options for Castrate sensitive prostate cancer

A

Bilateral orchidectomy GNRH agonists - Goserelin, Leuprolide GNRH antagonists - Degarelix Chemotherapy

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36
Q

What is the issue with using GNRH agonists?

A

Clinical flare phenomenon - cancer intially grows with hormone flare. Increased risk of cardiovascular disease.

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37
Q

Mutation causing EGFR agent resistance

A

T790M

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38
Q

drug for T790 mutation in NSCLC

A

Osimertinib

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39
Q

EGFR mutation location

A

exon 19 deletion.

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40
Q

BRAF pathway resistance is caused by

A

MEK mutation

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41
Q

drug used to prevent BRAF V600 pathway resistance

A

MEK inhibitor - Trametinib

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42
Q

Lapatinib MOA

A

TKI against HER2

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43
Q

Ribociclib MOA

A

CDK4/6 inhibitor - causes reactivation of Rb which causes G1 cell cycle arrest.

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44
Q

Drug used to increase 5FU half life in CRC treatment

A

Leucovorin

45
Q

Definition of stage 4 lung ca

A

metastatic disease OR malignant effusion OR lesion in contralateral lung.

46
Q

MOA of p53

A

causes cell cycle arrest in G1 if there is any DNA damage or mutation.

47
Q

Radiotherapy technique to prevent radiation when moving/breathing

A

Gating - only emits beam when location is within field - therefore will stop/adjust if tumor moves outside field during breathing.

48
Q

Genetic condition causing renal cell carcinoma

A

Von Hipple Lindau - regulates hypoxia inducible factor 1α (HIF1α).

49
Q

Von Hipple Lindau disease symptoms and signs

A

Symptoms - neurological + visual + ataxia. angiomatosis, hemangioblastomas, pheochromocytoma, renal cell carcinoma, pancreatic cysts, epidydimal cysts.

50
Q

In which cancers is nucleotide excision repair most important?

A

Lung and skin cancer. Nucleotide excision repair removes DNA damaged by carcinogens (smoking and sun damage)

51
Q

Most common SE of Bevacizumab

A

Hypertension

52
Q

Treatment of Carcinoid syndrome

A

Octreotide

53
Q

Drug combination used for chemotherapy induced nausea and vomiting prevention

A

Dexamethasone + Ariprepitant + 5HT3

54
Q

Most emetogenic chemo agent

A

Platinum’s

55
Q

Best drug for preventing metastatic fractures

A

Denosumab (better than Zolidronic acid)

56
Q

Management of SVC syndrome

A
  1. FNA for histological diagnosis 2. Radiation
57
Q

Cause of fatigue in CTLA4 use

A

adrenalitis

58
Q

Mx of stage 3 CRC and duration.

A

Surgical resection + Adjuvant FOLFOX - can have 3 months of chemo unless T4 or N2 (then need 6 months)

59
Q

When to use Cetuximab/ Panitumumab in CRC

A

KRAS wild type

60
Q

CRC screening guidelines

A

Image

61
Q

MOA of Pertuzumab

A

Strops HER2-HER3 dimerization

62
Q

MOA of Fulvestrant

A

Oestrogen receptor down-regulation

63
Q

GnRH ANtagonist

A

Degaralix

64
Q

Management of Limited stage SCLC

A

Chemoradiotherapy + whole brain radiotherapy

65
Q

Management of extensive stage SCLC

A

Chemotherapy + Atezolizumab (PDL1)

66
Q

Difference between Cisplatin and Carboplatin

A

Cisplatin - more tocix, increased neurotox, ototox, renal toxicity.

Carboplatin - less toxic, more myelosuppression.

67
Q

Difference between treatment in MSI low and MSI high stage 2 CRC

A

NO adjuvent chemotherapy if MSI high

68
Q

MSI high stage 4 CRC treatment

A

Good response to immunotherapy.

69
Q

Best immunotherapy for L sided CRC vs R sided CRC

A

L sided - EGFR inhibitors (but must be RAS wild type)

R sided - VEGF inhibitor

70
Q

Management of Stage 4 NSCLC with PDL1 expression <50%

A

Chemotherapy + Pembrolizumab

71
Q

Management of Stage 4 NSCLC with PDL1 expression >50%

A

Pembrolizumab monotherapy

72
Q

Cause of myoclonus in a palliative care patient

A

Neurotoxicity with opioids - associated with metal clouding. Reduce opioids where possible and start benzo’s

73
Q

PSA testing option for Men over 50.

A

Offer PSA testing every 2 years until the age of 69, and offer further investigations if the PSA is > 3.0 ng/m

74
Q

Indications for BRCA testing

A
  • triple negative breast cancer
  • ovarian cancer
  • male breast cancer
  • breast cancer + 1 relative with breast cancer
  • breast ca + more than one relative w breast ca
  • breast ca + more than one relatives with prostate cancer or pancreatic cancer
  • breast cancer and Ashkenazi Jew
  • NO breast ca + 2x first degree relatives w breast ca <50
  • A relative with a known BRCA1 or BRCA2 mutation
75
Q

Management of menopause symptoms post breast cancer therapy.

A

Cannot use hormonal therapy as usually used in menopause due to breast ca risk.
nonhormonal pharmacotherapy such as gabapentin SSRIs/SNRI. If on tamoxifen, SSRIs can interfere with CYP2D6 metabolism - Venlafaxine interacts the least.

76
Q

MOA of PARP

A

single strand base excision repair

77
Q

How much radiation is in a mammogram

A

3 months worth of normal sun exposure

78
Q

Type of breast cancer commonly missed on mammography

A

lobular

79
Q

When to discontinue anthracyclines (Doxorubicin)

A
  • symptomatic heart failure
  • EF <50%
  • absolute decrease in EF >10%
80
Q

Mechanism of cardiotoxicity with Capecitabine/ 5FU

A

Coronary artery vasospasm. Do not rechallenge

81
Q

Cardiac SE of most ‘nibs

A

long QT and hypertension

82
Q

what are the HER tyrosine kinase inhibitors

A

neratinib and lapatinib

83
Q

Management of HER2 agent (Trastuzumab) cardiotoxicity

A

Withhold agent for 4 weeks if:

  • symptomatic
  • EF drop by >16%
  • EF <45%
84
Q

Best agent for RADIATION induced nausea

A

Ondansetron

Dexamethasone if brain radiation

85
Q

Management of radiation cystitis

A

use of a urine alkaliser

use of NSAID

use of alpha-1 blocker

86
Q

Drug causing verrucal keratosis (wart looking) and Plantar-palmar hyperkeratosis

A

BRAF and MEK inhibitors

87
Q

For patients on CTLA4 and PD1 agents, which should be ceased first in immune related diarrhoea

A

cease CTLA4 (grade 2) , could continue PD1 once symptoms improve.

DO NOT give steroids if bowel perforation is present

88
Q

Management of immunotherapy cardiac toxicity

A

cease agents. DO NOT recommence.

High dose steroids

Cardiology referral

89
Q

Immunotherapy related side effects and manegement

A
  1. Cardiotoxicity - cease treatment
  2. Endocrinopathies. Continue treatment and give steroids unless adrenal crisis. Give hormone replacement. Treat T1DM with insulin.
  3. GI tox/diarrhoea - continue treatment in grade 1. Withhold until improved in grade 2. Cease CTLA in grade 3, cease both in grade 4.
  4. Haematological - all of the immune cytopenias
  5. Hepatitis
  6. Inflammatory arthritis - paracetamol, NSAISD, pred.
  7. Neuro - aseptic meningitis, myasthenia gravis, GBS, neuropathy.
  8. Pulmonary toxicity
  9. Renal - tubulointerstitial nephritis
  10. Rash/ SJS
90
Q

Management of immunotherapy related kidney disease

A

Grade 1 - Creatinine >1 to 1.5 x ULN
or >1.0 to 1.5 x baseline, monitor only. Dont cease agents

Grade 2 - Creatinine >1.5 to 3.0 x ULN
or >1.5 to 3.0 x baseline. Withold treatment and give steroids. Recommence treatment if it improves.

Grade 3/4 - Creatinine >3.0 x ULN
or >3.0 x baseline. Cease treatment and give steroids

91
Q

Chemo agent causing capillary leak and pulmonary oedema due to systemic release of cytokines

A

gemcitabine

92
Q

Management of radiation pneumonitis

A

Corticosteroids* - Pneumocystis jiroveci infection (PJP) prophylaxis is recommended

Consider bronchodilators (limited evidence). Consider humidifier (limited evidence). Supplemental oxygen if required.

93
Q

Mutation found in Gastro intestinal stromal tumors (GIST) (2)

A

PDGFRA and KIT

94
Q

Benefit of GNRH antagonists (degaralix) over GNRH (goserelin/ leuprorelin) agonists in prostate cancer.

A
  • reduced cardiovascular mortality
  • faster onset of efficacy without initial surge seen on agonists
95
Q

For what mutation is entrectinib used for?

A

NTRK fusion - seen in <1% of cancers.

96
Q

How to determine if chemo is needed for HR+, HER2- breast cancer

A

Oncotyping recurrance score is done which includes 21 genes.

High score >26 needs chemo.

Low score <25 does not need chemo unless age <50

97
Q

vinyl chloride exposure is a RF for which cancer

A

Glioma

98
Q

Genetic syndromes with increased risk of CNS cancer

A
  • NF1
  • Von hipple Lindau
  • Tuberous sclerosis
99
Q

Treatment for CNS cancers

A
  1. Temozolomide - purine methylator
  2. PARP inhibitors.
  3. Chemo - localised carmustine wafer.
100
Q

Breast cancer therapy also good for osteoporosis

A

Raloxifene

101
Q

Hormone therapy for breast cancer in young women vs post-menopausal women

A

Young - SERMs - Tamoxifen.

Old/ post menopause - Aromatase inhibitors (Anastrozole/Letrozole), the SERM Raloxifene is also beneficial for osteoporosis.

102
Q

Role of Leucovorin in chemotherapy regimes

A

increases half life of 5FU

103
Q

Colorectal ca follow up screening

A

CEA 3 monthly

CT CAP yearly for 3 years

colonoscopy at 3 and 5 years

104
Q

Follow up maker for anorectal cancer

A

ctDNA

105
Q

Chemo for Gastric cancer

A

HER2 agents if HER2 positive

FLOT chemo - flurouracil, leucavorin, oxaliplatin, taxanes

106
Q

Chemo for testicular cancer

A

BEP - bleomycin, etoposide, platinums

107
Q

Biggest RF for ovarian cancer

A

advanced age

108
Q

Which agent adds survival benefit to ovarian cancer when used with chemotherapy

A

VEGF inhibitors

109
Q

Which type of chemotherapy have better efficacy/SE for ovarian cancer - IV or peritoneal.

A

Peritoneal

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