Medical Oncology Flashcards
(94 cards)
1
Q
Screening for average risk group - asymptomatic with no personal hx of CRC/UC or family hx
A
FOBT 2nd yearly age 50-74
2
Q
Screening for moderately increased risk group - 1st deg relative w CRC & age<55 or
Two 1st/2nd deg relatives w CRC
A
Colonoscopy every 5 yrs from age 50 OR 10 years younger than age of 1st dx of bowel ca in family
3
Q
Screening for patients with HNPCC
A
Colonoscopy 1-2 yearly from age 25
4
Q
Gene & chromosome assoc w Familial adenomatous polyposis
A
loss of APC gene on chrom 5
5
Q
Extracolonic features of FAP
A
gastric/duodenal polyps, desmoid, thyroid, brain tumours
6
Q
Indication of colectomy in FAP
A
- documented/suspected CRC
- adenoma w high grade dysplasia
- significant sx (GI bleed)
- marked increase in polyp number
- inability to survey colon due to multiple diminutive polyps
7
Q
Mismatch repair genes associated with HNPCC
A
MLH1, MSH2, PMS2, MSH6
8
Q
Amsterdam criteria (3:2:1) to identify patients at risk of HNPCC
A
- 3 or more relatives w Lynch assoc Ca, one is a 1st deg relative
- Lynch assoc ca involving at least 2 generations
- 1 or more diagnosed before age 50
9
Q
Lynch associated cancers
A
- colorectal
- endometrial
- ovarian. stomach
- hepatobiliary
- TCC ureter, kidney
- gastric, pancreas
- brain
10
Q
Role of folinic acid with 5FU in chemotx
A
increases 5FUs half-life
11
Q
Surveillance for curatively treated CRC
A
- colonoscopy: full colonoscopy at conclusion of tx (if haven’t had one) then at 3 years then 5 yrly
- phy exam + CEA:: 3mthly for 3 yrs, then 6 mthly
- CT CAP annually for 3 yrs
12
Q
Which gene more associated with left-sided vs right-sided colorectal cancer? which tx to use?
A
Left - RAS wild type -> responds to EGFR inhibitor
Right - BRAF mutation - poorer prognosis - use bevacizumab
13
Q
EGFR inhibitors used in RASwt
A
cetuximab, panitumumab
14
Q
Difference between EGFR inhibitors used in RASwt & EGFR+ve in NSCLC
A
cetuximab, panitumumab target extracellular EGFR vs intracellular for erlotinib, gefitinib in NSCLC
15
Q
Toxicities in EGFR inhibitors
A
acneiform rash, hypoMg/hypoCa, pneumonitis, diarrhoea, xerosis (dry skin), paronychia
16
Q
SEs of Bevacizumab
A
HTN, wound breakdown, GI perforation, proteinuria, thromboembolic events
17
Q
Ix in Carcinoid syndrome
A
urinary 5-HIAA, chromogranin-A (good use for disease progression f/up)
18
Q
Tx for carcinoid syndrome
A
somatostatin analogues: octreotide (short-acting), lanreotide (long-acting)
19
Q
When to use maintenance Olaparib in pancreatic ca
A
BRCA2 +ve
*olaparib = PARP inhibitor
20
Q
Which patient group with colorectal cancer may benefit using PD1 inhibitor
A
MMR deficient mets CRC
21
Q
Histology types of ovarian ca
A
Mucinous (usually mets from GI tract)
Endometroid
Clear cell
High grade serous
22
Q
Which patient group with ovarian ca to test for BRCA1/2 in patients?
A
Age <70yo wt high-grade non-mucinous epithelial ovarian/ fallopian tube/prim peritoneal ca
23
Q
Chemo tx regime for ovaria ca if:-
- optimally debulked
- suboptimally debulked/stage IV
- stage III/IV with BRCA 1/2 mutant
A
- optimally debulked -> IP chemo
- suboptimally debulked/stage IV - carbo/taxol + bevacizumab
- stage III/IV with BRCA 1/2 mutant - carbo/taxol then maintenance Olaparib
24
Q
What does it mean by platinum resistant recurrent ovarian ca?
A
recurrence <6 months from last treatment
25
Risk factors of endometrial cancer
```
unopposed oestrogen (nulliparity, early menarche, late menopause, obesity, PCOS [chronic anovulation], tamoxifen) age, Lynch syndrome
*OCP is protective
```
26
Tx of endometrial ca
TAHBSO +/- sentinel LN sampling + peritoneal ax +/-omental biopsies
27
Types of HPV related to cervical ca
16 & 18
28
Predictors of relapse in cervical ca
Uterine corpus & lymph node involvement
29
Tx regime for FIGO IB2- IVA cervical ca
definitive concurrent chemoradiation - cisplatin weekly + 50.4Gy whole pelvis radiotx + 12Gy brachytx
30
Palliative tx regime for metastatic cervical ca
Carboplatin/Paclitaxel + bevacizumab
31
gene mutation more likely related to breast ca in men & prostate ca
BRCA2
32
Syndrome associated with sarcomas, adrenal, brain ca with breast cancer risk >90%
Li-Fraumeni syndrome (TP53)
33
Syndrome & gene assoc w thyroid, endometrial, GU ca with breast cancer risk 25-50%
Cowden (PTEN)
34
Syndrome & gene assoc w benign hamartomatous polyps, hyperpigmented macules on oral mucosa with breast cancer risk 50%
Peutz-Jaghers syndrome (STK11/LKB1)
35
Cancers associated with Peutz-Jaghers syndrome
```
Breast ca (50%)
small intestine
colorectal
sex cord tumours
uterine
testicular
```
36
Syndrome & gene a/w diffuse gastric ca
Hereditary diffuse gastric ca (CDH1)
37
Type of breast ca a/w hereditary diffuse gastric ca
lobular breast ca - 40% risk
38
Poor prognostic features of breast cancer
```
+ve axillary LN,
increasing size,
higher grade (higher % of Ki-67),
ER/PR -ve,
untreated HER2 overexpression,
younger age,
lymphovascular invasion
```
39
subtypes of breast ca & respective tx regime
- Luminal A (ER/PR +ve, low HER2) -> no chemo
- Luminal B (weaker ER, higher HER2) -> consider chemotx
- HER2 enriched -> chemo + trastuzumab
- Triple -ve -> Chemotx
40
Indications of mastectomy for breast ca
- Multi-centric
- Large tumour
- Imaging concerns - diffuse malignant appearing calcifications
- Prior chest RT
Inflamm breast ca
41
Risks of Tamoxifen (SERM)
ER antagonist on breast but agonist on bone & uterine
- endometrial hyperplasia
- VTE
42
Risks of aromatose inhibitor e.g. anastrozole
Osteoporosis
43
Risks of trastuzumab & what type monitoring is needed?
Reversible cardiac toxicity
| Monitor LVEF 3 monthly
44
Likely sites of mets for these advanced breast ca:-
- ER+ve
- HER2+ve
- Triple -ve
- ER+ve - bone & LN mets
- HER2+ve - brain mets
- Triple -ve - visceral mets
45
Tx regime for HR+ve advanced breast ca
Palbociclib + fulvestant/aromatose inhibitor
46
Mechanism of action & AEs of Palbociclib
CDK4/6 inhibitors - inhibition activates tumour suppressor retinoblastoma protein (pRB) & causes cycle cycle arrest
47
Tx regime for Triple -ve Breast Ca
usually sequential single agent +/- atezolizumab (PD-L1 inhibitor)
Alternative: PARP inhibitor - Olaparib
48
Which individuals with breast cancer should be considered for BRCA genetic testing
- triple negative age<50
- triple negative with 1st/2nd degree relative w breast/ovarian ca
- age <40
49
Syndrome & gene a/w cerebellar/spinal haemangiomas, retinal angioma & renal cell ca
von Hippel-Lindau syndrome (VHL gene)
*tumour suppressor gene on Chr3 -> loss of heterozygosity at vHL locus -> overproduction of VEGF -> role in tumour angiogenesis
50
Tx regime for palliative intent mets RCC
```
good prognosis: sunitinib/pazopanib
intermediate & poor-risk: Nivolumab + Ipilimumab
MTOR inhibitor(everolimus) is 2nd line
```
51
Mechanism of action of Sunitinib
multikinase inhibitor: - Inhibits VEGF receptor TK, PDGF receptor & c-kit oncogene
52
Adverse effects of Sunitinib
lethargy, HTN, stomatitis, hypothyroidism, hand-foot syndrome, hepatitis, neutropenia, thrombocytopenia, LV dysfunction
53
1st & 2nd line Androgen deprivation therapy for metastatic prostate ca
1st line: GNRH agonist (Goserelin/Leuprorelin)
+ docetaxel (for high vol dx - 4 bone mets)
+ testosterone antagonist (bone mets)
2nd line: complete androgen blockage - GNRH agonist + testosterone antagonist (bicalutamide)
54
Why is testosterone antagonist needed with GNRH agonist for prostate ca with bone mets
GNRH agonists acts as agonist for 1st 2 weeks before being antagonist; testosterone antagonist prevent growth of mets causing malignant pain & rarely spinal cord compression
55
Treatment regime for castrate-resistant prostate ca
- Total androgen blockade (GNRH agonist & Bicalutamide)
- Docetaxel/Prednisolone
- Enzalutamide
- supportive tx - Zoledronate/Denosumab
56
Mechanism of action & SEs of Docetaxel
- Taxane -> inhibits disassembly of microtubules during cell cycle -> inhibits cell division. Inactivates bcl-2 ->apoptosis
- SE: alopecia, n&v, pancytopenia, fluid retention, peripheral neuropathy
57
Mechanism of action of Abiraterone
blocks synthesis of testosterone in adrenal gland
58
Contraindication of Abiraterone
cardiac dx & avoid in diabetes as need prednisolone (causes adrenal insufficiency)
59
Mechanism of action & contraindication of Enzalutamide
- Androgen receptor antagonist
| - Avoid pts w neurological cdtns (e.g. epilepsy), memory/cognitive impairment
60
which type of testicular cancer has elevated HCG but normal AFP?
seminoma, choriocarcinoma
61
which type of non-seminoma testicular cancer has very elevated AFP?
yolk-sac tumor
62
Markers of poor prognosis in testicular cancer
AFP >10k
bHGC >50k
LDH >10x ULN
63
Chemotx for metastatic testicular ca
BEP - bleomycin/etop/cisp
Cisplatin-resistant (relapse within 4 weeks) - VIP (vinblastine, ifosfamide, cisplatin/TIP
64
Significant predictors of melanoma
Breslow depth of lesion & presence of ulceration
65
Types of melanoma
Radial growth phase: superficial spreading, lentigo maligna, acral lentiginous
Vertical growth phase: Nodular
66
Type of melanoma a/w intermittent sun exposure
Superficial Spreading Melanoma
67
Type of melanoma a/w large amounts of cumulative UV exposure
Lentigo Maligna (Hutchinson's Melanotic Freckle)
68
Type of melanoma accounts for almost all in Africans & most in Asians
Acral lentiginous
69
Adjuvant tx for stage 3B/C/D & 4 of melanoma
- Dabrafenib & Trametinib for BRAF mutation
| - Nivolumab/Pembro regardless of PDL1 expression or BRAF mutation
70
Mechanism of action of Dabrafenib & Trametinib
BRAF & MEK inhibition
71
gene mutation related to intermittent sun exposure
BRAF
72
gene mutation related to chronic sun exposure
KIT, CDK4
73
gene mutation related to acral exposure
NRAS, KIT
74
Adverse effects of Dabrafenib
Pyrexia, hyperkeratosis, arthralgia, rash, keratoacanthoma, squamous cell ca, hyperglycaemia
75
Difference between Dabrafenib vs Vemurafenib vs Encorafenib
Vemurafenib - no CNS activity Encorafenib - less pyrexia rate
76
When is Imatinib used melanoma?
patient with KIT mutation
77
Definition of limited stage small cell lung ca
All disease within one radiation field (ipsi lung & hilar/mediastinal LN)
78
Examples of EGFR & ALK inhibitors
EGFR inhibitors - Gefitinib, erlotinib, afatinib
| ALK inhibitors - Crizotinib, Alectinib
79
When is Osimertinib used?
EGFR mutation with T790M resistance mutation in NSCLC
80
When to use single agent PD(L)1 inhibitor in NSCLC
>50% PD-L1 expression
81
Examples of PD-1 inhibitors & PD-L1 inhibitors
PD-1 inhibitors: Nivolumab, Pembrolizumab
| PD-L1 inhibitors: Atezolizumab, Avelumab, Durvalumab
82
Histological types of mesothelioma
Epithelioid & sarcomatoid (poorer prog)
83
Difference between Alectinib & Ceritinib from Crizotinib as ALK inhibitor
Alectinib & Ceritinib have good CNS penetration
84
Screening recommendation for HNPCC carrier patient
annually or 2 yearly with colonoscopy around the age 25 or 5 years before youngest family member diagnosed with cancer
85
What is the upfront treatment for acneiform rash caused by EGFR antibodies?
moisturizer, doxycycline and topical steroid
86
Toxicities of 5-FU, Capecitabine
- Mucositis
- Diarrhoea
- Plantar-palmar erythrodysesthesia (Hand-foot syndrome) - Capecitabine >5-FU
87
Which patient group tx with 5 F-U/capecitabine has higher risk of myelosuppression & mucositis?
dihydropyrimidine dehydrogenase deficiency in 2-8% population
88
Difference between prognostic vs predictive markers
Prognostic markers - info on outcome, independent of therapy
| Predictive markers - info on outcome with regards to a specific therapy
89
Most common site of spine causing spinal cord compression
Thoracic - 60%
| - lumbar 25%, cervical 15%
90
What is founder effect?
high frequency of specific gene mutation in a population founded by a small ancestral group
91
Screening for BRCA1/2, PALB2 mutation carrier
- Breast Screening to commence at age 25yrs
- Risk reducing BSO from 40yrs
Or 5 years earlier than the youngest person affected
92
Screening for Lynch Syndrome
- MHL1/ MSH2: Screening colonoscopy from 25yrs
- PMS2/ MSH6: Screening colonoscopy from 30yrs
- Risk reducing TAHBSO from 40 yrs
Or 5 years earlier than the youngest impacted
93
Screening for FAP
Screening colonoscopies from 12yrs Or 18 yrs in AFAP until colectomy
94
Screening for VHL gene mutation carrier
- Annual exam with BP from 2 yrs
- Annual plasma or urine metanephrine screening from 2yrs
- Annual abdominal screening Alternating US/ MRI from 10yrs
