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Flashcards in Cancer Deck (181):
1

Name 6 aetiologies of cancer?

Genetic
Chemica
Physical- radiation
Diet
Drugs
Infective

2

H.pylori associated with what cancer/

MALT tumours

3

HPV associated with which cancers?

Oral, anal and cervical

4

Non hodgkin and other Lymphoma is associated with which infection?

EBV nuclear antigens

5

100 fold increase of hepatocellular carcinoma from what?

Hep B

6

How do retroviruses increase chances of cancer?

Overexpression of oncogenes, can lead to T cell lymphoma

7

which commonly prescribed drugs can increase the chances of cancer?

Immunosuppresants

8

Most commonly used staging measure in cancer?

TNM

9

What does grade refer to in cancer ?

How far or not does the tissue resemble normal GX-G3

10

What is the definition of a partial response to cancer treatment?

Radiologically shrinking of at least 30% but disease still present.

11

Stable disease in cancer is defined how?

Less than 20% increase in size, or a less than 30% decrease in size.

12

Progressive disease is defined how?

>20% increase in new lesion size

13

MRI is gold standard for imaging which tumour types?

Neurospinal, rectal, MSK, some head and neck sub types and prostate

14

CEA is used as a marker for which disease?

Colorectal carcinoma

15

What may give false positive raised CEA?

Smoking, IBD, pancreatitis, and hepatitis

16

CA125 raise associated with which cancer?

86% of ovarian tumours have this

17

Tumour marker produced by hepatocelluar carcinoma, some teratomas, prognosis?

Alpha fetoprotein++ = poor prognosis

18

HCG raised in which tumours?

Hydatiform mole and choriocarcinoma, elevation of specific B units in non seminomatous testicular cancer.

19

What is the value of PSA tyesting?

Can be raised from prostate exam, UTI or BPH, useful in assessing response however.

20

Immunoglobulins role in cancer diagnoses?

Can be present with myelomas, also bence jones proteins in urine. Occasionally raised in non hodgkins.

21

% patients curative with surgical resection?

30%

22

Which metastatic sites may be resected curatively in metastasis?

Solitary lung masses from sarcomas, localises liver mets from colorectal.

23

What is neoadjuvant chemo, and why?

Chemo before a surgery, shrink tumour, better margins- established in osteosarcomas, being tested elsewhere.

24

Primary chemo uses?

Inoperable, uncertainty, may make surgery with curative intent feasible

25

Adjuvant chemo uses?

Treatment of micromets after surgery = higher survival

26

Curative chemo in which diseases?

Often childhood, germ cells or lymphomas... often more intensive treatments.

27

Principles of multi drug chemo regimes?

significant single agent activities, non overlapping toxicity, different mechanisms.

28

What is high dose chemo, problems and treats what?

Chemo requiring bone marrow support, often through transplantation of bone marrow or stem cells. Can be curative in disease such as lymphoma, myeloma and leukaemias also germ cell tumours. Significant morbidity and mortality- 1-2%

29

After how many days post chemo does bone marrow suppression often occur and what is lowest point known as?

10-14 days - lowest point of drop know as nadir

30

Neutrophil count significant infection

0.5x10^9/L

31

Recovery of bone marrow occurs how long after?

3-4 weeks, matches with cycles of chemotherapy

32

Paralytic ileus may occur with which drugs?

Vinca alkaloids, and platinum based

33

What may be used to reduce hair loss in chemo?

Cold cap

34

Platinum, vincas ands taxanes often cause which neuro complications?

Residual defect of the peripheral sensory nerves, sometimes recovers but often doesnt.

35

Ifosamide and 5fu may be associated with CNS toxicity such as?

Encephalopathy and cerebellartoxicity.

36

High tone hearing loss may be associated with which chemo?

Cisplastin, pre-existing damage precludes use

37

Bladder toxicity caused by?

cyclophosphamide and isofamide

38

Nephrotoxic chemos?

Cisplatin and isofamide

39

Cardiac toxicity associated with which chemos?

Doxirubicin and paclitaxel = arrhythmia

40

Coronary artery spasm can be a complication of which chemo?

5-fu

41

Chemo causing photosensitivity?

5-fu

42

Pulmonary fibrosis and pigmentation caused by which chemo abx?

Bleomycin

43

Most common type of chemo to cause secondary malignancies?

Alkylating agents

44

Infertility is caused by which agents?

Alkylating

45

Pneumonitis associated with which type of chemo?

Alkylating

46

Haemoglobin below what level prompts consideration for transfusion in cancer patients?

10g/dl, can be associated with lower quality of life

47

Thrombocytopaenia levels and when to take action?

Below 10= take action significant risk of spontaneous bleed
10-20 usually supported with transfusion especially when infections are present
20+ not routinely requiring transfusions

48

Most frequent complication of myelosuppression?

Neutropenic sepsis

49

Total white cell count below what with fever requires in patient management?

below 1x10^9/L

50

Trastuzumab (herceptin) used for what?

Her2+ disease in breast cancer

51

Ipilimumab used in what metastatic disease?

Melanoma

52

CLL and non hodgkin can use what monoclonal antibody?

Rituximab

53

What do tyrosine kinase inhibitors end with (drug name) ?

"ib" eg Sunitinib

54

What do Mtor inhibitors end in (drug name)

"us" eg everolimus, useful in renacl cell and metastatic breast disease

55

Goserelin, what does it do, useful for what?

Block sex hormones, useful in some breast and prostate cancers

56

How does tamoxifen work?

Blocks the action of oestrogen

57

Example of a steroidal anti androgen?

Cyroterone acetate, inhibit andrgoen in tumour and substitute for testosterone in hypothalamus = negative feedback.

58

Approx what % of patients are cured with radiotherapy?

40%

59

How does radiotherapy work v briefly?

Electrons fired with a linac, secondary electrons in body made "free radicals" destroys DNA growth stops. Normal cells can repair usually cancer cells defective

60

What is the small dose of radiotherapy called?

A fraction

61

The full dose of radiation to be delivered is measured in what unit?

Gray Gy

62

What is concurrent chemotherapy thought to do ?

Act as a radiosensitiser and enhance the response to radiotherapy.

63

Acute effects of radiotherapy treatment?

Diarrhoea, mucositis and local skin irritation

64

Late effects of radiotherapy when ?

3 months plus, effects can last years, include lung fibrosis, infertility and skin atrophy

65

What are the 3 phases of clinical trials?

phase 1 -establish toxicity and maximum dose, disease response not an end point

phase 2- assess anti tumour activity, no control, tumour shrinkage is outcome usually

phase 3- comparing new with conventional treatments, randomised

66

A screening test for cancer ideally would...?

Detect early, sensitive and specific, tolerated, easy to administer, inexpensive, and publicised.

67

What is the most effective screening program?

Cervical smears

68

When are womern invited for smears?

25-49 every 3 years and 49+ every 5 years (in england)

69

When and to whom is mammography offered?

47-70 years every 3 years although over 70 can request still

70

Bowel screening takes place what ages? what does it do?

Faecal occult blood, every 2 years, ages 60-69 (extended to 74 in england.

71

What % of cancer patients have pain?

80%

72

Describe bone pain and management in cancer?

dull, widespread ache or tenderness over bone. NSAIDS, radiotherapy and bisphosphonates

73

Describe visceral cancer pain, treatments too?

Dull, deep seated, poorly localised. Can be spasmodic or over organ areas,colicky pain = anticholinergic (buscopan), capsule pain = steroids other pain = opiates usually.

74

Raised ICP headache features and treatment?

Worse on coughing, when waking, bending forward sneezing nausea and vomiting also. often treated with steroids, NSAIDs and paracetamol.

75

Describe neuropathic pain?

Altered sensation, less defined areas, numbness, pallor sweating tingling burning. Anti convulsants help gabapentin etc also TCA amitryptiline... steroids helpful for compression

76

Side effects of opiates?

Constipation, drowsiness (on dose change), confusion (rarely hallucination), resp depression, addicition and dependance, nausea and vomiting

77

Two forms of morphine? how long acting? examples?

Immediate release- 4hrs relief, extended up to 12hrs relief. Immediate- sevredol and oramorph
extended- zomorph MST continus

78

Max strength codeine switching to morphine extended approx dose?

20mg BD

79

Renal impairment alternatives to morphine?

Fentanyl

80

What fraction of total dose should breakthrough dose be in morphine?

1/6

81

Converting oral morphine to diamorphine subcut would require dividing by what?

3 as diamorphine is 3 times as potent

82

Subcut morphine is how much as potent as oral morphine?

Twice so divide oral by 2 to get sc dose

83

Megestrol acetate and dexamethasone may be used to promote what?

Eating though effects often wear off

84

4 main causes of vomiting?

Cerebral, Gastric, Toxic, indeterminate

85

Gastric stasis anti emetic?

Metoclopramide 10-20mg

86

Toxic nausea causes?

drugs, infection, uraemia, hypercalcaemia

87

Treatment for toxic vomiting?

Haloperidol 1.5-5mg nocte (sedative effect)

88

Cerebral causes of vomiting?

raised ICP, tumour, morning headache, vomiting without nausea

89

Cerebral vomiting treatment?

Dexamethasone 8-16, and or cyclizine 50mg tds

90

Anticipatory nausea treatments?

Benzos, CBT and therapy

91

Intractable or unknown cause vomiting consider?

Levopromazine 6.25-12mg (very sedating)

92

How often should laxatives be reviewed in palliative care?

2 days

93

Stool softener examples?

Docusate and lactulose

94

Bulk forming laxatives use in palliative?

rarely used

95

Stimulatn laxatives?

Senna and dantron

96

Combination laxatives used in palliative?

Movicol + co-danthramer

97

What is co-danthrusate?

Danthramer + docusate

98

What may ocreotide be used for in cancer patients?

Bowel obstruction

99

Causes of sudden onset dyspnoea in cancer patients?

Asthma, Pulmonary oedema, PE

100

SOB arising over days in cancer pts?

COPD exacerbation or pneumonia, bronchial obstruction, SVC obstruction

101

Gradual on SOB in cancer pts?

Anaemia, pleural effusions, ascites, Lymphangitis

102

Common cancers causing spinal compression?

Breast, prostate and bronchus

103

Where do 2/3 of metastatic spinal lesions occur?

Thoracic

104

Signs and symptoms of spinal compression?

Back or nerve root pain, weakness, bladder and bowel dysfunction (late sign insidious), "walking on cotton wool"
Painless bladder distention, increased reflexes below lesion.

105

How soon should MRi be done if suspecting compression? What given?

Within 24hrs, give dex (16mg)

106

Definitive management of compression of cord?

Radiotherapy, surgery, combination

107

Symptoms and signs of SVC obstruction? Causes?

usually bronchial/lymphoma tumour but any solid tumour can cause it.
Headache, fullness in head, facial swelling, SOB, hoarseness, engorged vessels neck and chest

108

SVC obstruction treatment?

Commence high dose dex, stenting treatment of choice often chemo and radio also given

109

Hypeercalcaemia associated with what?

Usually breast, lung myeloma and scc's but any tumour can cause it. Do not need bone mets to have hypercalcaemia

110

Symptoms of hypercalcaemia?

Malaise, anorexia, polyuria, polydipsia, N&V, constipation, confusion, fits, coma.

111

Initial management of hypercalcaemia?

Rehydrate with IV fluids.

112

Definitive management of hypercalcaemia?

IV bisphosphonates zolendronic acid, 70% respond to treatment

113

Most common female cancer?

Breast- 19% of all female cancers.

114

Risk factors for breast cancer?

Increased age, (more oestrogen)> null parity, early menarche, late menopause obesity
HRT, radiation, BRCA,

115

Most common breast cancer type/

Ductal

116

How are breast cancers graded?

Due to differentiation - 1 being good 3 being poor

117

Common presentation of breast cancer?

Lump- less commonly nipple changes and discharge or metastatic disease.

118

What is triple assessment?

history imaging and then biopsy if needed (USS best in <35years)

119

Primary management of localised breast cancer?

Surgery, mastectomy or conservative wide local exision, assessment of local nodes

120

When is radiotherapy offered with breast cancer?

After surgery and sometimes in mastectomy pts if large mass was found, if full axillary node clearance has occurred should not use radiotherapy. Sentinel node biopsy increasing use

121

Factors to consider for systemic therapy of breast cancer?

Hormone status receptors, menopause, previous response, performance status.

122

What is tamoxifens roles?

Blocks oestrogen provides benefit to recurrence in oestrogen positive cancers. Reduced contralateral cancer seen regardless of ER Status.

123

Tamoxifen side effects/risks?

Increased endometrial cancer, and thrombotic problems.

124

Aromatose inhibitors useful when and how/

Block oestrogen, superior to tamoxifen in post menopausal women, can be used after 2-5years of tamoxifen to continue the effects. Can cause osteoporosis

125

HER 2 treatment?

Trastuzamab (herceptin helpful)

126

Ovarian ablation why and how?

Chemo induced menopause or oopherectomy to reduce the oestrogen

127

Metastatic patients who responds best to endocrine treatments?

ER positive 50-60%

128

Poor prognosis factors for breast cancer?

ER negative HER2 positive, higher grades >5cm size lymph involvement

129

How common lung cancer?

2nd most common after the most common breast and prostate in men and women.

130

Risk factors for lung cancers?

Smoking (80-90% cases) Age, occupational exposures

131

Most common lung cancer type?

Non-small cell

132

Small cell cancers often associated with what ?

Neuroendocrine secretion, acth or adh

133

% lung cancer seen on xray? % sputum cytology?

95% and 80%

134

Chance of metastasis in SCLC?

very high early on

135

Management of Small cell?

Chemo 99% response with combined chemo but often relapse after 12 months with resistant disease. rarely surgical

136

Radiotherapy value in small cell?

Adjuvant primary treatments, cranial to avoid mets and palliative

137

Prognosis of small cell?

2-4 months or 11 with treatment

138

Management of non small cell?

Most die within a year, although stage 1 and 2 resections have good prognosis over 5 years(80%)

139

Surgery useful in what % of non small?

30% mediastinal involvement usually precludes surgery

140

Use of radio in nsclc?

Can help but only 20% survival in stage 1/2

141

Chemo for non small cell?

Limited effectiveness up to 30% response but duration is short.

142

Risk factors for colorectal cancer?

Diet, rich in animal fats and meat, poor in fibre common in western world.Inflammatory diseases, Familial conditions.

143

% cancers in rectum?

40%

144

Majority of colon cancer what type?

Adeno

145

How many rectal tumours can be felt?

3/4

146

Tumour marker for colorectal?

CEA, but not diagnostic

147

Dukes staging?

A-wall confined, B- invading through C-lymph node involvement D-Metastases

148

Usual treatment for colon cancer?

Radical resection, early stage usually achieves cure

149

Radiotherapy value colorectal?

Usually used in rectal tumours

150

Chemo for colorectal?

Yes role in dukes stage C not great evidence to suggest dukes B benefit. 5 FU most active agent.

151

Prognostic factors for colorectal?

Lower age <40 possible more aggressive tumour

152

Screening for colorectal?

60-74 year old faecal occult blood 10% detected 44% in early stages

153

Incidence of testicular cancer what ages?

15-45 years 20/million population

154

Risks for testicular cancer?

Non descended testicles, family history or atrophy of testicle

155

What type of tumour most testicular and cure rate?

Germ cells 95% high cure rate divided in to non semitous 60% and seminomas 40%

156

Investigations for testicular cancer?

USS, bHCg raised in seminomas and non seminomas up to 75% patients. Alpha fetoprotein only if non seminomatous present. LDH can be helpful to monitor progress.

157

Main treatment for testicular cancer?

Orchidectomy through inguinal canal for treatment and biopsy

158

Chemo for testicular cancer?

Can use one dose carboplatin for seminoma
Non seminoma 2 cycles (BEP bleo etop and cisplatin) very intense

159

Value of radiotherapy testicular?

Para aortic nodes, but one dose carboplatin has been show to be just as effective and less complications.

160

Prognostic factors testicular?

Highly raised markers seminos >4cm Pulmonary metastases not affecting prognosis

161

Incidence of prostate cancer in white and black males?

Most common cancer in men 1/8 white males 1/4 black males.

162

Aetiology of prostate cancer?

No clear links, diet, BRCA2 and steroid use may be linked

163

Type of cancer prostate and where?

Adenocarcinoma usually posterior of the prostate- BPH often central

164

Gleason grading scale?

T1- no palpable mass T2 cancer within, T3 cancer breaching capsule T4 cancer extending out of capsule(rectum/bladder)

165

Symptoms of prostate cancer?

Usually asymptomatic, poor stream, dribbling, nocturia, frequency or metastatic features

166

Main treatment for prostate cancer?

Observation is best if confined to prostate, raised psa but no clinical signs is unknown evidence

167

Surgery options for prostate cancer?

Can resect but significant mortality, trans urethral resection palliatively used or to help urinary symptoms.

168

Radiotherapy in prostate cancer uses?

Can be used as adjuvant, can be alternative to surgery should be at least 6/52 after TURP to avoid strictures.

169

Hormonal treatment for prostate cancer?

Can be effective in reducing androgens and work in up to 80%. May be used to downsize/grade tumour prior to surgery. Eamples goserelin. Anti androgens cyproterone acetate.

170

Chemo for prostate cancer?

Docitaxel and carbazitaxel improves quality of life in metastatic disease.

171

Prognosis prostate cancer?

good usually if not advanced, serum psa high correlates with worse prognosis.

172

% pts with unknown primary, what needs to be thought about?

10% holistic approach, fitness, co-morbidities, probable sites and patient wishes need to be thought about.

173

Most likely site of unknown adenocarcinoma?

GI breast ovary lung

174

Squamous unknown primary could be?

Lung head and neck

175

Young men midline disease think what cancers?

possible germ cell tumour which may be cured!

176

Women with axillary or thoracic nodes but no known primary?

Treat as breast cancer

177

Women with abdominal carinamatosis?

Treat as ovarian

178

men with bony mets treat?

As prostate

179

Multiple medium sized nodal areas no known primary?

Treat as lymphoma

180

Treatment basis of unknown cancers?

Epirubicina nd platinum based cover msot solid tumours and 5fu for GI. Radiotherapy may be given for palliation

181

Poor prognostic factors for unknown origin cancers?

Male, increased organ sites. hepatic, adenocarcinomas