Onco Flashcards by Shanxi Jen

AD transmission

Multiple GI hamartomatous polyps

Mucocutaneous hyperpigmentation: Lips, Palms

10-20% lifetime risk of CRC

Also ↑ risk of other Ca:

Pancreas, Lung, Breast, Ovaries and uterus, Testes

Peutz Jeghers

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features of Peutz Jeghers?

AD transmission

Multiple GI hamartomatous polyps

Mucocutaneous hyperpigmentation: Lips, Palms

10-20% lifetime risk of CRC

Also ↑ risk of other Ca:

Pancreas, Lung, Breast, Ovaries and uterus, Testes

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Mutation in APC gene on Chr 5

(TSG Promotes β-catenin degredation. β-catenin is an oncogene which → cell

proliferation)

Cells then acquire another mutation to become Ca: p53, kRAS

AD transmission

~100% risk of CRC by 50yrs

Familial Adenomatous Polyposis

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Familial clustering of cancers

Lynch 1: CRC

Lynch 2: CRC + other Ca

(Ovarian, Endometrial, Pancreas, Small Bowel, Renal pelvis)

Mutations in DNA mismatch repair genes

AD transmission (variable penetrance)

Often Right-sided CRC

Present @ young age: <50yrs

HNPCC

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what genes are assoc w Breast Ca?

BRCA1 (also Ovarian Ca) and BRCA2 (male breast Ca)

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mx of hyperCa secondary to malignancy?

Aggressive hydration
- 0.9% NS (e.g. 1L/4h)

Monitor volume status
Frusemide when full to make room for more fluid

If 1^O HPT excluded, give maintenance therapy w bisphosphonate: zoledronate is good

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Ix of HyperCa in malignancy?

high Ca

low PTH (key to exclude 1^oHyperPTH)

CXR

Isotope bone scan

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Mx of raised ICP in malignancy?

Dexamethasone

Radio/Chemotx

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Ix to investigate raised ICP in malignancy?

CT/MRI

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Tumour Lysis Syndrome features?

massive cell destruction ->

high K, urate, phosphate

low Ca

-> renal failure

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How to prevent tumour lysis syndrome?

↑ fluid intake + allopurinol 24h before chemo

Rasburicase is an option

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Causes of SVC obstruction?

Usually lung Ca

Thymus malignancy

LNs

SVC thrombosis: central lines, nephrotic syndrome

Fibrotic bands: lung fibrosis after chemo

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Features of SVC Obstruction?

Headache

Dyspnoea and orthopneoa

Plethora + thread veins in SVC distribution

Swollen face and arms

Engorged neck veins

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What sign is specific for SVC obstruction?

Pembertons sign:

Lifting arms above head for >1min → facial plethora, ↑JVP and inspiratory stridor

Due to narrowing of the thoracic inlet

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Ix of SVC obstruction?

Sputum cytology

CXR

Venography

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Mx of SVC obstruction in malignancy?

Dexamethasone

Consider balloon venoplasty + SVC stenting

Radical or palliative chemo / radio

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Prophylaxis of neutropenic sepsis?

co-trimoxazole

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Ix of spinal cord compression in malignancy?

urgent MRI spine

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presentation of spinal cord compression?

Back pain, radicular pain

Motor, reflex and sensory level

Bladder and bowel dysfunction

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Mx of spinal cord compression due to mets?

Dexamethasone

Discuss w neurosurgeon and oncologist

Consider radiotherapy or surgery

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AFP tumour marker?

HCC

teratoma

non-malignant causes: hepatitis, cirrhosis, pregnancy

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CA 125 tumour marker?

Ovary

Uterus

Breast

non-malignant: cirrhosis, pregnancy

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CA 15-3 tumour marker?

Breast

non-malignant:

benign breast disease

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CA 19-9 tumour marker?

Pancreas

cholangiocarcinoma

CRC

non-malignant:

cholestasis

pancreatitis

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CA 27-29 tumour marker?

breast

neuron-specific enolase tumour marker?

SCLC

CEA tumour marker?

colorectal cancer non-malignant: pancreatitis, cirrhosis

BHCG tumour marker?

germ cell tumour non-malignant: pregnancy

PSA tumour marker?

prostate non-malignant: BPH

Monoclonal Ig tumour marker?

Multiple Myeloma

S-100 tumour marker?

Melanoma Non-malignant: sarcoma

PLAP tumour marker?

Seminoma

Acid phosphatases tumour marker?

Prostate Ca

Thyroglobulin Tumour marker?

Thyroid Ca

Reasons for chemotherapy?

**Neoadjuvant** Shrink tumour to ↓ need for major surgery Control early micrometastases **Primary Therapy** E.g. sole Rx in haematological Ca **Adjuvant** ↓ chance of relapse: e.g. breast and GI Ca **Palliative** Provide relief from symptoms Prolong survival

Trastuzumab?

anti-Her2 for HER2+ve breast ca

Bevacizumab?

anti-VEGF for RCC, CRC, lung

Cetuximab?

Anti-EGFR Colorectal Ca

Erlotinib?

Tyrosine Kinase inhibitor lung ca

Imatinib?

tyrosine kinase inhibitor CML

Ibrutinib?

tyrosine kinase inhibitor CLL

Common side effects of chemotx?

N+V: prophylactic antiemetic + dexamethasone Alopecia Neutropenia Extravasation of chemo agent: pain, burning, bruising @ infusion site. Stop infusion, give steroids, apply cold pack

SE cytotoxic abx bleomycin?

pulmonary fibrosis

SE of cyclophosphamide (alkylating agent -chemotx)?

haemorrhagic cystitis hair loss BM suppression

which chemotx agent has a SE of haemorrhagic cystitis?

Cyclophosphamide

SE of doxorubicin (cytotoxic Abx)?

Cardiomyopathy

SE of 5-FU?

Mucositis

which chemotx agents cause SE of peripheral neuropathy?

Vincristine Carboplatin (+ nephrotoxic + n/v)

Reasons for surgery in malignancy?

**Diagnostics**: tissue biopsy or complete removal **Excision**: GI, soft-tissue sarcomas, gynae Often with neo-/adjunctive chemo or radiotherapy **Palliation**: e.g. bypass procedures, stenting

Mechanism of Radiotx?

Ionising radiation → free radicals which damage DNA Normal cells better at repairing damage than Ca cells Radiation dose: gray (Gy) Given in daily fractions India ink tattoo for reproducible targeting

Reasons for radio tx in malignancy?

**Radical Rx** Curative intent 40-70Gy 15-30 daily fractions **Palliation** Symptom relief Bone pain, haemoptysis, cough, dyspnoea, bleeding. 8-30Gy 1-10 fractions

Early reactions to radiotx?

Tiredness Skin reactions: erythema → ulceration Mucositis n/v: occur w stomach, liver or brain Rx Diarrhoea: pelvic or abdo Rx Cystitis BM suppression

Late reactions to radiotx?

Brachial plexopathy: Follows axillary radiotherapy -\>Numb, weak, painful arm Lymphoedema Pneumonitis: Dry cough ± dyspnoea-\> Rx: prednisolone Xerostomia Benign strictures Fistulae ↓ fertility Panhypopituitarism

Conversion of dose from oral codeine to oral morphine?

Divide by 10

conversion of dose from oral tramadol to oral morphine?

divide by 10

conversion of dose from oral morphine to oral oxycodone?

Divide by 1.5 (used to be 2) Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation

conversion of dose from oral morphine to subcut morphine?

Divide by 2

conversion of dose from oral morphine to subcut diamorphine?

Divide by 3

conversion of dose from oral oxycodone to subcut diamorphine?

Divide by 1.5

what transdermal patch equates to approximately 30 mg oral morphine daily?

transdermal fentanyl 12 microgram patch

Onco Flashcards

(60 cards)