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BPT > Oncology > Flashcards

Oncology Flashcards

1
Q

Polyp type with highest risk of malignant transoformation

A

Villous

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2
Q

Treatment of mCRC with MSI

A

PD-1 therapy

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3
Q

Treatment of mCRC wild type RAS/BRAF

A

FOLFOX chemo + EGFR inhibitor (cetuximab)

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4
Q

Treatment of mCRC with mutant RAS/BRAF

A

FOLFOX chemo + VEGF inhibitor (bevacizumab)

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5
Q

A/E EGFR inhibitors

A

Acneiform rash

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6
Q

A/E bevacizumab

A

Impaired wound healing
GI perforation

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7
Q

MoA of irinotecan

A

Topoisomerase inhibitor

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8
Q

A/E of 5FU/Capeceitabine

A

Hand foot syndrome = palmar, plantar erythrodesia
Coronary vasopasm

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9
Q

Prior to using 5FU/capecitabine, check?

A

DPD (dihydropyrmidine dehydrogenase) - lack this, cannot metabolise, get significant myelosuppression

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10
Q

Metastatic malignancy, acute SOB, unexplained, CXR shows bilateral infiltrates

Suspect?

A

Lymphangitis carcinomatosis

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11
Q

Metastatic malignancy, acute SOB, features R heart strain with hypoxia, clear lungs

Suspect?

A

Pulmonary tumour embolism

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12
Q

Ki-67 - overactivity?

A

Cell proliferation

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13
Q

Ki-67 inhibition

A

inactivation of ribosomal RNA synthesis

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14
Q

SERM for breast cancer - which cell cycle phase

A

G1

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15
Q

Mammography underestimates which type of breast cancer?

A

Lobular

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16
Q

Breast cancer type that recurs after 10 years

A

ER positive

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17
Q

Breast caner type with bone mets

A

ER positive

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18
Q

Breast cancer type with brain mets

A

HER2 positive

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19
Q

EGFR (epidermal growth factor) receptor
- intracellcular signalling pathways (2)

A

Ras –> Raf –> MEK –> erk
- CRC check for RAS and RAF
- Melanoma - check for RAF and MEK

Pi3 –> MTOR
- Breast cancer - use CDK inhibitors first, then Pi3 inhibitors, then mTOR

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20
Q

Angiogenesis growth factors

A

VEGF
Platelet derived growth factor
Fibroblast growth factor

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21
Q

Where do Cyclin dependant kinase inhibitors act on?

A

G1/S phase

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22
Q

Epigenetics
- Anti-cancer treatments based on this

A

Hypomethylating agents
- Azacitidine for high risk MDS

Histone deacetylase (HDAC) inhibitors
- Vorinostat used in cutaneous T cell lymphoma

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23
Q

Vorinostat
- MoA
- Use

A

HDAC inhibitor
Cutaneous T cell lymphoma

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24
Q

2nd line neuroendocrine tumours?

A

Radiolabelled somostatin analogues

–> Peptide receptor radionucleotide therapy (PRRT)

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25
Q

MSI on CRC
- What differentiates Lynch (germline) from Sporadic

A

Sporadic may have BRAF mutation

Lynch will note have BRAF

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26
Q

Genetic defect in MUTYH associated polyposis

A

Deficient base excision repair

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27
Q

Pairs of mismatch repair proteins

A

MLH1 and PMS2
MSH2 and MSH6

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28
Q

Management of met CRC?

A

MSI? - PD1 single agent

Otherwise FOLFOX/FOLFIRI chemotherapy with:
- RAS/RAF wildtype - cetuximab (EGFR inhibitor)
- RAS/RAS mutant - bevacizumab (VEGFR)
- HER2 over-expressed - HER2 inhibitor

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29
Q

What is border of R sided vs L sided CRC

A

Splenic flexure. After splenic flexure = L, Before = R

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30
Q

CRC staging
- Into muscularis propria but not through

A

T2

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31
Q

CRC staging
- Limited to mucosa and submucosa

A

T1

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32
Q

CRC staging
- Invasion through muscularis propria
- Into peritoneal cavity

A

Through - T3

Into periteonal cavity - T4

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33
Q

Biggest predictor of CRC recurrence?

A

Lymph node sampling

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34
Q

BRAF inhibitor in mCRC
- Agent?
- When to use

A

Encorafenib

mCRC. RAS wildtype, BRAF mutant.
Can use cetuximab and ecorafenib, with idea BRAF inhibitor may overcome EGFR resistance

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35
Q

Spindle shaped cells

A

GIST

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36
Q

Kit-117

A

GIST

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37
Q

Gene for diffuse gastric cancer

A

CDH1

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38
Q

Hereditary diffuse gastric cancer
- cancers
- inheritance and cause

A

Germline mutation in CDH1 –> autosomal dominant

Signet ring cell gastric cancer and lobule breast cancer

39
Q

Which gland of prostate are majority of prostate cancer cases?

A

Posterior gland

40
Q

Significance of gleason score

A

x2 core biopsies of prosate. Grades differentiation out of 5, adds two score together.

6 or less is grade 1, very unlikely to metastasise (however can be sampling error)

41
Q

1st line for met castrate sensitive prostate cancer

A

ADT + docetaxel + androgen receptor antagonist

Can not use docetaxel if not candidate for chemotherapy

42
Q

1st line for nonmetastatic castrate resistant prostate cancer

A

Continue ADT

Add androgen receptor inhibitor

43
Q

1st line for metastatic castrate resistance prostate cancer
- Rapd
- Slow

A

Rapid - Continue ADT + add taxane

Slow - continue ADT and add novel anti-androgen/abiraterone

44
Q

2nd line for met castrate resistant prostate cancer after failure of anti-androgens and taxane

A

PMSA Lu-117

45
Q

A/E abiraterone

A

Adrenal insufficiency with lack of gc but mineralocorticoid excess (blocks 17a hydrooxylase)

Give concurrent prednisolone

46
Q

A/E enzalutamide

A

Increased risk falls and fractures

47
Q

ADT A/E
- Most common
- Others

A

Most commmon - sexual dysfunction

Others
- Osteoporosis
- CVD and diabetes
- weight gain
- Cognitive dysfunction

48
Q

Most common melanoma

A

Superfiical spreading

49
Q

Melanoma with best prognosis

A

Superficial spreading

50
Q

Tan/brown macule, older person, sun exposed area

A

Lentigno melanoma

51
Q

Palms/plantar/subungual melanoma

A

Acral lentignous

52
Q

Nodule with pink hue, melanoma

A

Nodular

53
Q

Protective for CINV?

A

ETOH

54
Q

Adjuvant beneficial agent for CINV

A

Olanzapine - can add to triple regimens

55
Q

BRCA 2 higher risk of?

A

Male breast cancer
Prostate

56
Q

BRCA 1 higher risk of?

A

Breast cancer
Ovarian cancer
(female)

57
Q

When to require axillary clearance in breast cancer

A

> 2 sentinel nodes positive

58
Q

Target membrane protein in refractor breast cancer conjugated to topoisomerase inhibitor

A

TROP-2

59
Q

Most common immunotherapy A/E

A

Skin

60
Q

Which immunotherapy has more common/severe A/E

A

CTLA4
- Hypophyisitis
- Pulmonary toxicity

61
Q

Which type of thyroid illness more common with immunotherapy

A

hypothyroidism

62
Q

When to use PJP PPx for patients receiving corticosteroids for IrAE

A

Concurrent chemo
Underlying lung conditions
> 6 weeks steroids/complicated A?E

63
Q

Requirements prior to using Fleischner guidelines for incidental pulm nodules

A

Age > 35
Baseline risk (i.e not screening)
Not immunocompromised
No history malignancy previously treated/followed up
No symptoms

64
Q

Single nodule

Benign characteristics no f/u requried

A

Fat appearance

Characteristic calcific appearance (harmatoma, granuloma)

65
Q

Pulm nodule > 8mm

A

CT 3 months or PET

66
Q

Pulm nodule < 6mm

A

No f/u

67
Q

Pulm nodule 6-8mm (solid or cystic)

A

CT 6-12 months

68
Q

What suggest malignant pulm nodule

A

Growing >2mm at seria CT

69
Q

Stable pulm esion

A

Stable size > 2 years

70
Q

4t’s anterior mediastinal mass

A

Thymoma
Teratoma
Thyroid
Terrible lymphoma

71
Q

Pharm management for hot flushes 2nd to tamoxifen

A

Venlafaxine

Avoid fluox/parox due to CYP2D6 interaction

72
Q

Breast cancer histopath with poor prognosis

A

Micropapillary

73
Q

Indications for mastectomy rather than wide local excision of early breast cancer

A

Multicentric

Large tumour

high ris features

CI to radiotherapy (previous RT etc)

74
Q

Predictive assay for early breast cancer
- tool that can be used to decide if adjuvant chemo needed

A

OncotypeDX Rs

75
Q

1st line therapy for met ER positive brast cancer

A

Premenopause - Tamoxifen + CDK4/6 inhibitor + ovarian function suppression

Post-menopausal - aromatase inhibitor + CDK4/6 inhibitor

76
Q

2nd line for met ER positive breast cancer

A

Fulvestrant
Pi3 inhibitors - idealialisib
mTOR inhibitors

77
Q

1st line for met HER2 + breast cancer

A

Trastuzumab +/- pertuzumab
AND
Taxane chemo

78
Q

2nd line for HER2 met breast cancer

A

T-DM1 - trastuzumab emtansine

79
Q

3rd line for met her2 breast cancer

A

Lapatanib/capecitabine

80
Q

Triple negative breast cancer options

A

BRCA- PARP
PD1 - immunotherapy

81
Q

When to commence bone modifying agents in met breast cancer

A

When first evidence of bone metastasis

82
Q

Considerations prior to pulmonary resection for lung cancer

A

Predicted pulmonary function

Baseline FEV1 and DLCO, and volume of lung to be resected

83
Q

NSLC TNM staging

A

M = stage 4
N - contralateral mediastinal = IIIB, ipsilateral mediastinal = IIIA

Local nodes = limited disease

84
Q

SCLC - when to use radiotherapy to chest?

A

If limited disease - tumour only, or local lymph nodes

Any mediastinal lymph nodes precludes as involves too big a RT field

85
Q

Most common cause cancer death

A

Lung cancer

86
Q

Situations where IPC is better than talc pleurodesis

A

Life expectancy >2 weeks but < 2 months

Not wanting any inpatient stay

87
Q

Beware the man with glass eye and large liver

A

Ocular melanoma metastases to liver

88
Q

Single enlarge lymph node
or
Enlarge lymph nodes >3cm

A

Castleman’s disease

89
Q

Cytokine associated with castleman’s disease

A

IL-6

90
Q

Virus associated with multicentric castleman’s

A

HHV-8

91
Q

Metabolic changes cachexia

A

Catabolic
- Hypertriglyceridaemia
- Hypergylcaemia

92
Q

Opioid tolerant
Breakthrough acute opioid pain

A

S/L fentanyl

93
Q

Cancer screening program - indicator of effectiveness?

A

Cancer mortality

BPT (18 decks)

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