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Oncology Flashcards

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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
MSI on CRC - What differentiates Lynch (germline) from Sporadic
Sporadic may have BRAF mutation Lynch will note have BRAF
26
Genetic defect in MUTYH associated polyposis
Deficient base excision repair
27
Pairs of mismatch repair proteins
MLH1 and PMS2 MSH2 and MSH6
28
Management of met CRC?
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
29
What is border of R sided vs L sided CRC
Splenic flexure. After splenic flexure = L, Before = R
30
CRC staging - Into muscularis propria but not through
T2
31
CRC staging - Limited to mucosa and submucosa
T1
32
CRC staging - Invasion through muscularis propria - Into peritoneal cavity
Through - T3 Into periteonal cavity - T4
33
Biggest predictor of CRC recurrence?
Lymph node sampling
34
BRAF inhibitor in mCRC - Agent? - When to use
Encorafenib mCRC. RAS wildtype, BRAF mutant. Can use cetuximab and ecorafenib, with idea BRAF inhibitor may overcome EGFR resistance
35
Spindle shaped cells
GIST
36
Kit-117
GIST
37
Gene for diffuse gastric cancer
CDH1
38
Hereditary diffuse gastric cancer - cancers - inheritance and cause
Germline mutation in CDH1 --> autosomal dominant Signet ring cell gastric cancer and lobule breast cancer
39
Which gland of prostate are majority of prostate cancer cases?
Posterior gland
40
Significance of gleason score
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
1st line for met castrate sensitive prostate cancer
ADT + docetaxel + androgen receptor antagonist Can not use docetaxel if not candidate for chemotherapy
42
1st line for nonmetastatic castrate resistant prostate cancer
Continue ADT Add androgen receptor inhibitor
43
1st line for metastatic castrate resistance prostate cancer - Rapd - Slow
Rapid - Continue ADT + add taxane Slow - continue ADT and add novel anti-androgen/abiraterone
44
2nd line for met castrate resistant prostate cancer after failure of anti-androgens and taxane
PMSA Lu-117
45
A/E abiraterone
Adrenal insufficiency with lack of gc but mineralocorticoid excess (blocks 17a hydrooxylase) Give concurrent prednisolone
46
A/E enzalutamide
Increased risk falls and fractures
47
ADT A/E - Most common - Others
Most commmon - sexual dysfunction Others - Osteoporosis - CVD and diabetes - weight gain - Cognitive dysfunction
48
Most common melanoma
Superfiical spreading
49
Melanoma with best prognosis
Superficial spreading
50
Tan/brown macule, older person, sun exposed area
Lentigno melanoma
51
Palms/plantar/subungual melanoma
Acral lentignous
52
Nodule with pink hue, melanoma
Nodular
53
Protective for CINV?
ETOH
54
Adjuvant beneficial agent for CINV
Olanzapine - can add to triple regimens
55
BRCA 2 higher risk of?
Male breast cancer Prostate
56
BRCA 1 higher risk of?
Breast cancer Ovarian cancer (female)
57
When to require axillary clearance in breast cancer
>2 sentinel nodes positive
58
Target membrane protein in refractor breast cancer conjugated to topoisomerase inhibitor
TROP-2
59
Most common immunotherapy A/E
Skin
60
Which immunotherapy has more common/severe A/E
CTLA4 - Hypophyisitis - Pulmonary toxicity
61
Which type of thyroid illness more common with immunotherapy
hypothyroidism
62
When to use PJP PPx for patients receiving corticosteroids for IrAE
Concurrent chemo Underlying lung conditions > 6 weeks steroids/complicated A?E
63
Requirements prior to using Fleischner guidelines for incidental pulm nodules
Age > 35 Baseline risk (i.e not screening) Not immunocompromised No history malignancy previously treated/followed up No symptoms
64
Single nodule Benign characteristics no f/u requried
Fat appearance Characteristic calcific appearance (harmatoma, granuloma)
65
Pulm nodule > 8mm
CT 3 months or PET
66
Pulm nodule < 6mm
No f/u
67
Pulm nodule 6-8mm (solid or cystic)
CT 6-12 months
68
What suggest malignant pulm nodule
Growing >2mm at seria CT
69
Stable pulm esion
Stable size > 2 years
70
4t's anterior mediastinal mass
Thymoma Teratoma Thyroid Terrible lymphoma
71
Pharm management for hot flushes 2nd to tamoxifen
Venlafaxine Avoid fluox/parox due to CYP2D6 interaction
72
Breast cancer histopath with poor prognosis
Micropapillary
73
Indications for mastectomy rather than wide local excision of early breast cancer
Multicentric Large tumour high ris features CI to radiotherapy (previous RT etc)
74
Predictive assay for early breast cancer - tool that can be used to decide if adjuvant chemo needed
OncotypeDX Rs
75
1st line therapy for met ER positive brast cancer
Premenopause - Tamoxifen + CDK4/6 inhibitor + ovarian function suppression Post-menopausal - aromatase inhibitor + CDK4/6 inhibitor
76
2nd line for met ER positive breast cancer
Fulvestrant Pi3 inhibitors - idealialisib mTOR inhibitors
77
1st line for met HER2 + breast cancer
Trastuzumab +/- pertuzumab AND Taxane chemo
78
2nd line for HER2 met breast cancer
T-DM1 - trastuzumab emtansine
79
3rd line for met her2 breast cancer
Lapatanib/capecitabine
80
Triple negative breast cancer options
BRCA- PARP PD1 - immunotherapy
81
When to commence bone modifying agents in met breast cancer
When first evidence of bone metastasis
82
Considerations prior to pulmonary resection for lung cancer
Predicted pulmonary function Baseline FEV1 and DLCO, and volume of lung to be resected
83
NSLC TNM staging
M = stage 4 N - contralateral mediastinal = IIIB, ipsilateral mediastinal = IIIA Local nodes = limited disease
84
SCLC - when to use radiotherapy to chest?
If limited disease - tumour only, or local lymph nodes Any mediastinal lymph nodes precludes as involves too big a RT field
85
Most common cause cancer death
Lung cancer
86
Situations where IPC is better than talc pleurodesis
Life expectancy >2 weeks but < 2 months Not wanting any inpatient stay
87
Beware the man with glass eye and large liver
Ocular melanoma metastases to liver
88
Single enlarge lymph node or Enlarge lymph nodes >3cm
Castleman's disease
89
Cytokine associated with castleman's disease
IL-6
90
Virus associated with multicentric castleman's
HHV-8
91
Metabolic changes cachexia
Catabolic - Hypertriglyceridaemia - Hypergylcaemia
92
Opioid tolerant Breakthrough acute opioid pain
S/L fentanyl
93
Cancer screening program - indicator of effectiveness?
Cancer mortality

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