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Haem Onc Flashcards

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1
Q

presentation of SVCO
what is most common symptom

A

dyspnoea - most common
facial plethora
distended neck veins
headache

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2
Q

rx of SVCO

A

stent
chemo
dexamethasone

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3
Q

rx of malignant spinal cord compression

A

immobilise patient
loading dose 16mg dexamethasone
Urgent MRI whole spine within 24hrs

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4
Q

what type of cancer is prostate cancer
what is usual location

A

adenocarcinoma
peripheral zone

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5
Q

how is prostate cancer graded

A

gleason score - 2 grades given and added together - worse score is 10, best is 2

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6
Q

what can cause false positives for PSA

A

prostatitis
?DRE
UTI
BPH
exercise
ejaculation

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7
Q

RF for prostate cancer

A

increasing age
fhx
afro caribbean

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8
Q

presentation of prostate Ca

A

hesitancy
Retention
irregular hard prostate on PR
haematuria
back pain

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9
Q

first line ix of prostate cancer

A

multi parametric MRI

go on to do staging CT after if needed

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10
Q

Rx of prostate cancer
- localised
- locally advanced
- metastatic

A
  • can do conservative with active monitoring, radical prostatectomy or radio
  • GnRH agonists eg goserelin, radical prostatectomy, radiotherapy
  • radiotherapy, hormone treatments or palliative
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11
Q

How do GnRH agonists work in prostate cancer

A

initially cause a rise in testosterone - ‘tumour flare’ but then due to negative feedback it falls in about 2-3 weeks to castration levels

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12
Q

common complications of radical prostatectomy

A

urinary incontinence and erectile dysfunction

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13
Q

Breast cancer rx if
- ER +ve perimenopause
- ER +ve post menopause
- HER2 +ve

A
  • SERM - tamoxifen
  • aromatase inhibitors eg anastrozole
  • Herceptin + more recptove to chemo

lobotomy, mastectomy, ± axillary lymph node clearance, radiotherapy

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14
Q

Complication of aromatase inhibitors

A

osteoporosis - do DEXA scan

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15
Q

types of melanoma

A

lentigo
nodular
superficial spreading

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16
Q

grading of melanoma

A

breslows depth

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17
Q

shave vs punch biopsy for melanoma

A

shave doesn’t show whether its invasive as only samples epidermis, but can used for smaller lesions and won’t leave scar

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18
Q

rx of melanoma

A

curative - excision ±lump nodes
Chemo
Palliative
Topical imiquimod - immunotherapy

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19
Q

major and minor features of melanoma

A

major
- change in size
- change in colour
- change in shape

minor
- oozing or bleeding
- diameter >7
- altered sensation
- inflammation

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20
Q

excision margins based on breslows depth

A

Lesions 0-1mm thick 1cm
Lesions 1-2mm thick 1- 2cm
Lesions 2-4mm thick 2-3 cm
Lesions >4 mm thick 3cm

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21
Q

single most important prognostic factor in melanoma

A

breslows depth

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22
Q

colorectal cancer presentation

A

change in bowel habit
rectal bleeding
unexplained weight loss
bowel obstruction
abdo pain

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23
Q

2ww referral criteria for colorectal cancer

A

> 40 with unexplained weight loss and abdominal pain
50 with unexplained rectal bleeding
60 with iron deficiency anaemia or changes in bowel habit

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24
Q

what test is used first line for colorectal cancer since 2023

A

FIT testing

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25
colorectal cancer screening programme
FIT test, age 60 -74 every 2 years
26
inherited colon cancers, which is most common
hereditary non polyposis colorectal carcinoma (Lynch syndrome) - most common inherited Familial adenomatous polyposis
27
ix for staging in CRC
CEA staging CT CAP colonoscopy TNM or dukes staging
28
name of surgery if cancer is - right/transverse colon - left - sigmoid/upper rectum - anal
- right hemicolectomy - left hemicolectomy - high anterior resection - abdominoperineal resection of the rectum
29
what is hartmanns procedure
sigmoid resection + end colostomy
30
rf for colorectal cancer
- smoker - increasing age - male - fix - FAP + HNPCC - IBD
31
common side effects of chemo
N+v chemo brain weakened immune system - (bone marrow supression) mouth sores bruising and bleeding (thrombocytopenia)
32
side effects of radiotherapy - early and late
Early: skin reactions, mucositis, N+D, fatigue Long term: secondary malignancy endocrine - irreversible diabetes and hypothyroidism Neural or vascular damage RADIATION PNEUMONITIS - chest pain, cough, fevers
33
side effects of immunotherapy
every -itis hepatitis, scleritis, pneumonitis, myocarditis, nephritis, etc
34
Toxicity bear
cisplatin - ototoxic, nephrotoxic Bleomycin - pulmonary fibrosis vincristine - peripheral neuropathy Doxorubicin - cardiac issues Cyclophosphamide - bladder cancer Methotrexate - pulmonary fibrosis
35
what is myeloma and its features when does it present
proliferation of plasma cells Hypercalcaemia - light chains stimulate osteoclasts AKI - accumulation of light chains Paraproteinaemia Anaemia - bone marrow crowding surpasses erythopoeisis peak age is 70
36
ix of myeloma
bone profile FBC protein electrophoresis - increased IgA/G in serum and Urinary bence jones proteins U+Es - aki Bone marrow biopsy - >10% plasma cells Blood film - roleaux formation Xray - osteoporosis whole body MRI - lytic lesions
37
rx of myeloma
chemo + stem cell transplant + radiotherapy for bone pain and zolendronic acid to prevent bone disease
38
what is AML what age group
proliferation of myeloblasts adults - incidence increases with age
39
AML presentation
Symptoms of pancytopenia and general cancer sx
40
Rx of AML
chemo and regular blood transfusions palliative - pretty poor prognosis
41
Most common haem cancer in children
ALL
42
which haem cancer is associated with down syndrome
ALL
43
Pathophys of CML
proliferation of basophils, neutrophils, eosinophils etc
44
Presentation of CML What chromosome is it associated with
High white cell counts and massive splenomegaly Can progress ti AML
45
Rx of CML
Tyrosine kinase inhibitors eg imatinib generally have long remissions and normal life expectancy
46
FBC in chronic vs acute leukaemia
chronic - leukocytosis acute - pancytopenia
47
Complications of CLL
Richters transformation - CLL to lymphoma Hypogamaglobulinaemia - recurrent infections
48
who is CLL more common in
elderly
49
why is LDH high in cancers
bc high cell turnover
50
causes of pancytopenia
AML and ALL sepsis/DIC myelodysplasia SLE Radio/chemotherapy Drugs that cause bone marrow suppression
51
Pathophys of myelodysplasia and what can it progress to
Abnormal myeloid progenitor cells that clog bone marrow causing pancytopenia Can progress to AML
52
How is a progression to AML from myelodysplasia identified
>20% abnormal cells in the bone marrow
53
Rx of myelodysplasia
RBC and plt transfusions Abx for infections stem cell transplant chemo eg azacitidine to prevent AML progression
54
rf for hodgkins
prev EBV infection, HIV RA and sarcoidosis Fhx age - bimodal - peaks at 20 and 75
55
ix for Hodgkins
lymph node biopsy - reed sternberg cells LDH Staging CT
56
How many sets of lymph nodes does hodgkins usually affect
just 1
57
Staging system for lymphoma
Ann Arbor 1 - 1 set of lymph nodes 2 - 2 sets on same side of diaphragm 3 - 2 sets on opposite sides of diaphragm 4 - organ involvement
58
Rx of hodgkins
ABVD or RCHOP chemo Radiotherapy
59
compare hodgkins an non hodgkins
non hodgkins more common, tends to affect more than one set of lymph nodes, older pts, extra nodal involvement more common
60
what is essential thrombocytosis and what are pts at increased risk of
JAK2 mutation causing increase in platelets risk of clots, bleeding (bc plus bind to vWF causing reduced availability) and miscarriage
61
Rx of essential thrombocytosis - if low risk of clots - if high risk of clots
- aspirin, monitor - hydroxyurea, interferon alpha, plateletpheresies
62
what is polycythaemia vera and features what are they at increased risk of
JAK2 mutation causing overproduction of RBCs - fatigue, dizziness, itchy after hot shower, splenomegaly, redness, gout risk of clots!
63
Rx of PCV
regular phlebotomy hydroxurea Ruxolitinib - JAK2 inihibtor Aspirin for clot prevention antihistamines for itch
64
rx of neutropenic sepsis
IV tazocin Give vanc if concerned about line infection G CSF to stimulat neutrophil production
65
lab results and presentation of tumour lysis syndrome
hyperkalaemia hyperphosphataemia - hypocalcaemia increased uric acid Arrythmias Hypocalcium - tingling, muscle spasm, tetany, seizures AKI - uric acid
66
who is at risk of tumour lysis
large tumour burden rapidly dividing cancers eg AML, high grade lymphomas
67
when does tumour lysis occur
can occur spontaneously before treatment but most common in first few weeks after treatment
68
Rx of tumour lysis syndrome
Fluid resus Allopurinol (xanthine oxidase inhibitor) to reduce uric acid levels Rasburicase - converts uric acid so it is easily secreted May need temp dialysis bc of electrolyte imbalances
69
rx options for mucositis
difflam mouthwash oramorph tranexamic acid mouthwash if bleeding heavily from mouth
70

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