Onco I Flashcards
(57 cards)
1
Q
Define apoptosis
A
Programmed cell death
Individual cell deletion in physiological growth control and in disease
Energy dependent process for deletion of unwanted individual cells
DNA damage is monitored by p53
2
Q
Define necrosis
A
Death of cells/tissues from ischaemia, metabolic or traumatic causes
Failure of membrane integrity
3
Q
How are tumours classified
A
Behavioural: benign, malignant, borderline
Histogenic: cell of origin
4
Q
Features of a benign tumour
A
Localised Non invasive Closely resemble normal structure Circumscribed Nuclear morphology = normal Necrosis and ulceration is rare
5
Q
Features of a malignant tumour
A
Invasive Metastatic Rapid growth Variable resemblance to normal structure Poorly defined border Increased mitotic activity Necrosis and ulceration is common
6
Q
Discuss the pathophysiology of tumour invasion and metastasis
A
- Normal tissue
- Carcinogenesis
- Dysplasia
- In-situ neoplasia
- Invasive malignancy
- Metastatic cascade
- Metastatic disease
- Death
7
Q
Outline the TNM staging classification
A
T: extent of main tumour
N: presence and extent of regional LNs
M: presence of metastasis
8
Q
Indications for radiotherapy
A
Medically unfit for surgery Unresectable Close proximity to vital structures Neo-adjuvant to shrink structure Reduce risk of recurrence Palliative
9
Q
Types of radiotherapy
A
External beam radiation therapy
Internal radiation therapy
Stereotactic radiotherapy
10
Q
Complications of radiotherapy
A
ACUTE Fatigue Skin - erythema, dry and moist desquamation, irritation GI - loss of taste - oral mucositis - diarrhoea - N&V BM - cytopenia Lungs - pneumonitis
CHRONIC Infertility Lymphoedema Delayed healing Loss of salivary flow Lhermitte's Increased risk of CV events Hypothyroidism
11
Q
Side effects of chemotherapy
A
Myelosuppression - anaemia - infection - bleeding Alopecia Infertility Nausea, vomiting and diarrhoea Fatigue Mouth ulcers
12
Q
Define extravasation and list the treatments for it
A
Associated with chemotherapy Skin necrosis and amputation Rx - Topical agents (dimethy sulfoxide) - Heat - Cold - Debridement - Grafting
13
Q
List the types of immunological/ biological therapies
A
Monoclonal antibodies Non-specific immunotherapies Oncolytic virus therapy T-cell therapy Cancer vaccines
14
Q
Management of anaphylaxis
A
TI hypersensitivity reaction Stop the drug Perform ABCDE assessment Drugs - IM adrenaline - IV hydrocortisone - IV chlophenamine
15
Q
Features of neutropenic sepsis
A
- Risk due to myelosuppression
- Suspect in anyone who present with a fever who has had chemo in the last 6 wks
- Neutrophil counts <0.5
- Temp > 37.5
16
Q
Investigations in neutropenic sepsis
A
FBC LFT U&E Cr CRP Lactate Blood cultures Urine culture Swabs and culture from the central line Do not take LP can introduce infection
17
Q
Treatment of neutropenic sepsis
A
CULPRIT: ABVD
Tazocin
18
Q
Presentation of spinal cord compression
A
Pain
Sensory loss at the level
Weakness below the level
Loss of continence
70% thoracic
19
Q
Investigations in suspected spinal cord compression
A
MRI spine
Refer for neurosurgery
20
Q
Management of spinal cord compression
A
IV Dexamethasone (16mg/day + PPI)
Consider radiotherapy
Consider chemo + decompression surgery
Prevention VTE
21
Q
Management of painful spine mets
A
Analgesia (pain ladder)
Bisphosphonates (lytic lesions such as in myeloma or breast cancer)
Palliative radiotherapy
Vertebroplasty
22
Q
Management of DVT/PE
A
Cancer is prothrombotic, maintain a high index of suspicion DVT - Rx LWMH (Dalteparin) - 6 mnths of anticoagulation PE - Rx LWMH (Dalteparin) - 6 mnths of anticoagulation
23
Q
Management of Haemorrhage
A
Caused due to low platelets from chemo or disease process NSAIDS Topical tranexaemic acid Adrenaline soaks Oral transexaemic acid
24
Q
Mechanism of hypercalcaemia of malignancy
A
Secretion of PTHrP by tumour
Local release of factors increasing osteoclast proliferation
Autonomous production of calcitriol by lymphoma
25
Causes of hypercalcaemia of malignancy
Humoral
- Renal
- Ovarian
- Breast
- Endometrial
- Squamous cell carcinoma
Local osteolytic
- Breast
- Multiple myeloma
Calcitriol mediated
- Lymphoma
Ectopic PTHrP (small cell lung cancer)
26
Features of hypercalcaemia of malignancy
```
Dehydration
- poor skin tugor
Bone pain
Abdominal pain
Constipation
POLYURIA
Confusion
Fatigue
```
Shorted QT
27
Which medications make hypercalcaemia of malignancy worse
```
Thiazide diurectics
Calcitrol
Calcium
Antacids
Lithium
```
28
Management of hypercalcaemia of malignancy
IV normal saline
IV bisphosphonates/ denosumab
If fluid overloaded furosemide
29
Symptoms of SVC obstruction
```
Oedema of the faces and upper extremities
Dyspnoea
Facial plethora
Cough
Distended neck veins
Hoarse vocie
Fixed and raised JVP
Blurred vision
```
30
Investigations for SVC obstruction
Chest xray: widened mediastinum
CT thorax with contrast
USS upper extremities
31
Management of SVC obstruction
Secure the airway
Local radiotherapy
Corticosteriods (dex 10mg IV bolus)
Can try a percutaneous endovascular shunt if required
32
Define Tumour lysis syndrome
Combination of metabolic and electrolyte abnormalities occurring spontaneously following initiation of cytotoxic treatment in patients with cancer
Excessive cell lysis
Common in highly proliferative chemosensitive malignancies (lymphoma, leukaaemia)
33
Diagnostic criteria for TLS
```
LAB
2 of
- hyperuricaemia
- hyperphosphataemia
- hyperkalaemia
```
```
Clinical
2 of
- Increased Cr
- Arrhythmia (K+, PO4, hypoCa)
- Seizure
- Labs criteria
```
34
Outline the pathology of TLS
Malignant cells have high turnover
Produce high nucelic acid products + Phosphate
Ability of the kidney to eliminate large amounts is saturated
1. Hyperuricaemia + reduced urinary flow = AKI
2. Hyperphosphataemia , nephrocalcinosis = urinary obstruction
3. Secondary hypocalcaemia due to hyperphosphataemia
4. Hyperkalaemia from cell degradation
AKI leads to fluid overload and pulmonary oedema
35
Risk factors for developing tumour lysis syndrome
```
Haematological malignancy
Large tumour burden
High lactate dehydrogenase, WBC, uric acid pre treatment
Chemosensitive
Renal impairment
Dehydration
```
36
Presentation of tumour lysis syndrome
```
Syncope
Chest pain
Dyspnoea
Seizure
Nausea
Vomiting
Diarrhoea
Muscle weakness
Cramps
```
37
Investigations for tumour lysis syndrome
```
Serum uric acid
Phosphate
Potassium
Calcium
FBC
- elevated WCC
- serum creatinine
- lactate dehydrogenase
- serum urea
ECG
```
38
Strategies to avoid tumour Lysis Syndrome in
- Low risk
- Intermediate risk
- High risk
```
Low
- regular monitoring and assessment
- monitor biochemistry
- avoid nephrotoxic meds
(NSAIDs, aminoglycosides, IV contrast)
```
Intermediate risk
- Prechemotherapy IV hydration
- phosphate binders (aluminium hydroxide
- allopurinol or rasburicase
High risk
- prechemo IV hydration
- regular monitoring and assessment
- Phosphate binders
- Rasburicase
39
Acute management of tumour lysis syndrome
```
Treat hyperkalaemia
Intense fluid resuscitation
Phosphate binder
Rasburicase
Sodium bicarbonate
```
40
Define Lambert Eaton Myasthenic Syndrome
Rare AI disorder of the NM junction associated with SCLC
41
Pathology of Lambert Eaton syndrome
Circulating antibodies against the voltage gated calcium channels
Presynaptic membranes
Impair NM transmission by inhibiting calcium current and release of Ach to synpatic cleft
42
Presentation of Lambert Eaton syndrome
```
Limb weakness (proximal arms and legs)
Dry mouth (xerostomia + metallic taste)
Weakness (limb girdle + waddling gait)
Dysarthria
Ptosis
Diplopia
Impotence
```
43
Investigations for Lambert Eaton Syndrome
```
Nerve conduction studies: doubling of compound muscle action potential post excercise
Anti VGCaC +ve
Anti AChR -ve
Chest CT malignancy
Serial LuFT can causes resp crisis
```
44
Management of Lambert Eaton syndrome
No resp or bulbar weakness
- rx causes
- amifampridine
- pred
Resp invovlement
- Intubation
- Ventilation
- plasma exchange/ IVIG
45
Which cancers metastasies to bone
```
Breast
Prostate
Bronchus
Myeloma
Thyroid
```
46
List examples of familial cancer syndromes
Retinoblastoma
- Chr13
HNPCC
- AD
- Endometrial
- Stomach
- Ovarian
- Small bowel
- Pancreas
FAP
- AD
- 100% pentrance
Von Huppel Lindau
- AD
- Benign and malignant
- CNS
- Retinal
- Clear cell rena
- Phaeo
- Pancreatic
47
What is a sarcoma and give examples
```
Cancer of connective tissue
Soft tissue swelling + pain
- Liposarcoma
- Leiomyosarcoma
- Fibrosarcoma
- GIST
- Kapsoi's sarcoma
```
48
What is Edwing's sarcoma
Bone sarcome at young males
49
Investigations in suspected sarcoma
CT/MRI primary tumour
CT chest pul mets
HIV test
Biopsy for histology
50
Management of sarcoma
Excision
Radiotherapy
Chemotherapy
51
List the types of breast cancer
Ductal carcinoma
Lobular carcinoma: bilateral, fell harder
Mucinous
Medullary
52
Name the genes associated with breast cancer
BRCA1
| BRCA2
53
What receptors can be found on breast cancer
ER: control with anti-oestrogen tamoxifen or aromatase inhibitors in post menopausal women (anastrozole)
Her-2: control with herceptin
Ki67: proliferative marker
If triple negative poor prognosis
54
Investigation in breast cancer
```
Clinical
Histology/Cytology
- Fine needle aspiration
- Core biopsy
Radiology
- Mammography (XR)
- USS,solid vs cystic
Other
- LFT/Liver USS (mets)
- Ca + bone scan
- CXR
- Test receptors to guide treatment
```
55
Indications for mammography
```
Screening
Lump
Blood stained discharge
Familial risk
LCIS
```
56
Breast cancer treatment
1. Mastectomy
2. Lumpectomy
- must be followed by radiotherapy
3 -/+ recontruction
Axillary node clearance
- risk lymphoedema
- indicated is SNB +ve
Radiotherapy
- reduces recurrence
Chemotherapy
- Adjuvant
- increases survival reduces recurrence
Hormone
- premenopausal: tamoxifen (menopausal symptoms)
- Postmenopausal: aromatase inhibtors. Beware of the osteoporosis risk
- Trastuzumab (Herceptin)
57
Benign breast lumps
Fibroadenosis (painful breast at menstruation)
Green discharge (mammary duct ectasia)
Bloody discharge (Duct papilloma
Obese woman with trauma to the breast ( fat necrosis)
Lactating women with a hot tender breast (abscess)
